Investigation of the Effect of Demographic and Clinical Characteristics on Mortality of COVID-19 Patients Treated in the Intensive Care Unit: A Retrospective Study

Öz

Aim: COVID-19 can cause clinical pictures ranging from asymptomatic to severe respiratory failure and sudden death. The severity of the disease varies depending on many factors such as comorbidity, vaccination status, as well as demographic characteristics such as age and gender. In this study, it was aimed to investigate the independent risk factors that have an effect on mortality in COVID-19 patients. Materials and Methods: In the study, records of 140 patients with a diagnosis of COVID-19 followed in the intensive care unit between 01.01.2021 and 01.01.2022 were examined. Demographic characteristics such as age and gender, comorbidity, vaccination status and clinical course of the patient were investigated and recorded. Results: In our study, a statistically significant difference was found between mortality and age, and the number of days of total invasive/noninvasive mechanical ventilation support (p=0.01, p=0.25, p<0.001, respectively). It was found that mortality increased statistically significantly with the increase in the CO-RADS score (p=0.03). In addition, a statistically significant correlation was found between the vaccination status of the patients and mortality (p=0.03). Conclusion: In conclusion, the findings of the study showed that the mortality rate increased as age, duration of invasive or noninvasive mechanical ventilation support and lung involvement increased. It was also found that COVID-19 vaccines reduce mortality in patients hospitalized in intensive care.

Anahtar Kelimeler

• COVID-19
• intensive care
• comorbid disease
• COVID-19 vaccine
• mortality

Yoğun Bakım Ünitesinde Tedavi Edilen COVID-19 Hastalarının Demografik ve Klinik Özelliklerinin Mortalite Üzerine Etkisinin İncellenmesi: Retrospektif Çalışma

Öz

Amaç: COVID-19, asemptomatikten ciddi solunum yetmezliği ve ani ölüme kadar değişen klinik tablolara sebep olabilmektedir. Hastalığın şiddeti yaş, cinsiyet gibi demografik özellikler yanında, komorbidite, aşı durumu gibi birçok faktöre bağlı değişiklik gösterir. Bu çalışmada COVID-19 hastalarında mortalite üzerine etkisi olan bağımsız risk faktörlerinin ortaya konması amaçlandı. Gereç ve Yöntemler: Çalışmada 01.01.2021 ile 01.01.2022 tarihleri arasında yoğun bakım ünitesinde takip edilen COVID-19 tanılı toplam 140 hasta kayıtları incelendi. Hasta yaş, cinsiyet gibi demografik özellikler yanında, komorbidite, aşı durumu ve klinik seyri araştırılarak kaydedildi. Bulgular: Çalışmamızda mortalite ile yaş, toplam invaziv/noninvaziv mekanik ventilasyon desteği aldığı gün sayısı arasında istatistiksel olarak anlamı bir ilişki bulunmuştur (sırasıyla p=0,01, p=0,25, p<0,001). CO-RADS skorunun artmasıyla mortalitenin istatistiksel olarak anlamlı derece arttığı bulundu (p=0,03). Ayrıca hastaların aşı durumu ile mortalite arasında istatistiksel olarak anlamlı bir ilişki bulundu (p=0,03). Sonuç: Sonuç olarak çalışmanın bulguları yaş, invaziv ya da noninvaziv mekanik ventilasyon desteği aldığı toplam gün ve akciğer tutulumu arttıkça mortalitenin de arttığını gösterdi. Ayrıca COVID-19 aşılarının yoğun bakımda yatan hastalardaki mortaliteyi azalttığı bulundu.

Anahtar Kelimeler

• COVİD-19
• yoğun bakım
• komorbit hastalıklar
• COVİD-19 aşı
• mortalite

Kaynakça

1. 1. Sepandi M, Taghdir M, Alimohamadi Y, Afrashteh S, Hosamirudsari H. Factors Associated with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis. Iran J Public Health 2020;49(7):1211-21.
2. 2. Adhikari SP, Meng S, Wu YJ et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of corona-virus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty 2020;9(1):29.
3. 3. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed 2022;91(1):157-60.
4. 4. 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 Infect Dis. 2021;21(1):855.
5. 5. Fonseca EKUN, Loureiro BMC, Strabelli DG et all. (2021). Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population. Clinics, 2021;76.
6. 6. Taylor EH, Marson EJ, Elhadi M et al. Factors associated with mortality in patients with COVID-19 admitted to intensive care: a systematic review and meta-analysis. Anaestesia 2021;71(9):1224-32.
7. 7. Armstrong RA, Kane AD, Kursumovic E, Oglesby FC, Cook TM. Mortality in patients admitted to intensive care with COVID-19: an updated systematic review and meta-analysis of observational studies. Anestesia 2021;76(4):537-48.
8. 8. Jaillon S, Berthenet K, Garlanda C. Sexual dimorphism in innate immunity. Clin Rev Allergy Immunol 2019;56(3);308-21.

9. 9. Chinese Center for Disease Control and Prevention. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Chin J Epidemiol 2020;41:145-51.
10. 10. Verity R, Okell LC, Dorigatti I et al. Estimates of the severity of coronavirus disease 2019: A model-based analysis. Lancet Infect Dis 2020;20;669–77.
11. 11. 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.
12. 12. He Z, Charness N, Bian J, Hogan WR. Assessing the comorbidity gap between clinical studies and prevalence in elderly patient populations. IEEE EMBS Int Conf Biomed Health Inform.2016;136-9.
13. 13. Bagshaw SM, Webb SA, Delaney A et al. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care 2009;13(2):R45. doi:10.1186/cc7768.
14. 14. Kaben A, Corrêa F, Reinhart K et al. Readmission to a surgical intensive care unit: incidence, outcome and risk factors. Crit Care 2008;12:R123.
15. 15. Gaddam RR, Chambers S, Bhatia M. ACE and ACE2 in inflammation: a tale of two enzymes. Inflamm. Allergy Drug Targets 2014;13(4);224-34.
16. 16. 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.
17. 17. Li J, Huang DO, Zou B et al. Epidemiology of COVID-19: A systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes. J Med Virol. 2020; 93(3): 1449-58.
18. 18. Schmulson M, Dávalos MF, Berumen J. Beware: Gastrointestinal symptoms can be a manifestation of COVID-19. Rev Gastroenterol Mex 2020;85(3):282-7.
19. 19. Zhou Z, Zhao N, Shu Y, Han S, Chen B, Shu X. Effect of Gastrointestinal Symptoms in Patients With COVID-19. Gastroenterology 2020;158(8):2294-7.
20. 20. Lee JS, Godard A. Critical care for COVID-19 during a humanitarian crisis – lessons learnt from Yemen. Crit Care 2020;24:572.
21. 21. Gucyetmez B, Atalan HK, Sertdemir I et al. Therapeutic plasma exchange in patients with COVID-19 pneumonia in intensive care unit: a retrospective study. Crit Care 2020;24:492.
22. 22. Vecihe B, Nurcan SD, Ferhan DA et al. Risk factors associated with mortality in ıntensive care COVID-19 patients: the importance of chest CT score and intubation timing as risk factors. Turk J Med Sci 2021;51:1665-74.
23. 23. Sungurtekin H, Cansu O, Ulku A et al. Characteristics and outcomes of 974 COVID-19 patients in intensive care units in Turkey. Ann Saudi Med 2021;41(6):318-26.
24. 24. Rotshild V, Hirsh-Raccah B, Miskin I, Muszkat M, Matok I. Comparing the clinical efficacy of COVID-19 vaccines: a systematic review and network meta-analysis. Sci Rep 2021;11(1):22777.
25. 25. Zheng C, Shao W, Chen X et al. Real-world effectiveness of COVID-19 vaccines: a literature review and meta-analysis. Int J Infect Dis 2022;114:252-60.
26. 26. Liu Q, Qin C, Liu M, Liu J. Effectiveness and safety of SARS-CoV-2 vaccine in real-world studies: a systematic review and meta-analysis. Infect Dis Poverty 2021;10:132.
27. 27. Ling Y, Zhong J, Luo J. Safety and efectiveness of SARS-CoV-2 vaccines: a systematic review and meta-analysis. J Med Virol 2021;93(12):6486-95.
28. 28. Pormohammad A, Zarei M, Ghorbani S et al. Efcacy and safety of COVID-19 vaccines: a systematic review and meta-analysis of randomized clinical trials. Vaccines (Basel) 2021;9(5):467.