COVID-19 Salgınında Pnömonisi Olan Hastalarda Mortalite, Hastaneye Yatış ve Mekanik Ventilasyon Gereksinimlerinin Değerlendirilmesi

Öz

Amaç: COVID-19 salgını, pnömoniye bağlı mortalite nedeniyle önemli kayıpları beraberinde getirmiştir. Bu araştırmada, COVID-19 salgını sırasında başvuran atipik pnömoni vakalarında mortalite ve diğer kötü sonlanım prediktörlerini bulmayı amaçladık. Yöntem: Bu araştırma Mart ve Mayıs 2020 tarihleri arasında acil servisimizde yürütülen ileriye dönük kohort bir araştırmadır. Acil servise başvuran, toraks bilgisayarlı tomografisinde COVID-19 ilişkili atipik pnömoni patterni tespit edilen tüm erişkin hastalar araştırmaya dahil edildiler, bakteriyel pnömoni patterni olan hastalar ise dışlandılar. Araştırmanın primer sonlanım noktası; bir aylık süre içinde mortalite, yoğun bakım yatışı ve mekanik ventilasyon gereksinimi şeklinde birleşik sonlanım olarak planlandı. Bu hastalarda belirtilen kötü sonlanım prediktörlerinin araştırılması için bir lojistik regresyon modeli oluşturuldu. Bulgular: Toplam 271 pnömoni olgusundan 146'sı son analize dahil edildi. Dahil edilen hastaların 31'inde (%21,2) birleşik sonlanım gerçekleşti, 17 hasta bir aylık dönem içinde öldü. Son regresyon modeline hastaların yaşları, kalp yetmezliği öyküsü bulunması, inme öyküsü bulunması, vücut sıcaklığı, dispne, öksürük, bilinç değişikliği, ciddi bronkospazm, tomografide bilateral akciğer bulgusu olması, hemoglobin, LDH, laktat, bikarbonat ve kreatinin düzeyleri dahil edildi. Buna göre; hastalarda bilinç değişikliği olmasının (odds oranı [OO]:15,7, %95'lik güven aralığı [GA]: 1,7-141,6), ciddi bronkospazmın (OO:12,4, %95 GA:1,6-97,9) ve laktat düzeyindeki artışın (OO:1,1, %95 GA: 1,0-1,2) kötü sonlanımın bağımsız prediktörleri olduğu bulundu. Sonuç: Birçok klinik ve laboratuvar değişken arasından; bilinç değişikliği, ciddi bronkospazm ve laktat düzeylerinin kötü sonlanımı öngördüğü belirlenmiştir.

Anahtar Kelimeler

• COVID-19
• pandemi
• mortalite
• acil servis
• pnömoni

Prediction of Mortality, Hospitalization and Mechanical Ventilation Needs of Patients with Pneumonia in COVID-19 Outbreak

Öz

Objective: The COVID-19 pandemic has brought considerable loss to the world by means of pneumonia related mortality. In the current study, we aimed to discover the predictors of mortality and other worse outcomes in atypical pneumonia cases during the COVID-19 outbreak. Methods: A prospective cohort study was carried out in our emergency department (ED) between March and May, 2020. All adult patients presented to the ED with atypical pneumonia patterns related to COVID-19 based on a chest CT scan were included in the study, and patients with bacterial pneumonia patterns were excluded. The primary outcome measure was determined as the composite outcome, including mortality and intensive care unit admission or mechanical ventilation needs within a one-month period. A binary logistic regression model was constructed to predict the worse outcomes in those patients. Results: Of the 271 suspected pneumonia cases, 146 patients were included in the final analysis. The composite outcome occurred in 31 patients (21.2%), 17 of whom died within one month. The patients’ age, history of heart failure, history of stroke, body temperature, dyspnea, cough, altered mental status, serious bronchospasm, bilateral lung involvement, hemoglobin level, LDH, lactate level, and bicarbonate and creatinine levels were added to the final model. Finally, patients’ altered mental status (OR:15.7, 95%CI:1.7-141.6), serious bronchospasm (OR:12.4, 95%CI:1.6-97.9), and lactate levels (OR:1.1, 95%CI:1.0-1.2) were found to be independent predictors for worse outcomes. Conclusion: Among various clinical and laboratory variables, altered mental status, serious bronchospasm, and lactate levels can be used to predict worse outcomes.

Anahtar Kelimeler

• COVID-19
• pandemics
• mortality
• emergency department
• pneumonia

Kaynakça

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