Kovid-19 hastalarında eşlik eden kardiyo-metabolik hastalık sıklıkları ve klinik sonlanımlar üzerine etkileri

Yıl 2021, , 104 - 110, 31.12.2021

Mehmet Uzunlulu , Haluk Vahaboglu , Ayse Naciye Erbakan , Ümmügülsüm Durak , Lütfullah Caştur , Onur İncealtın , Özlem Aydın

https://doi.org/10.35514/mtd.2021.57

Öz

Amaç: Kovid-19 tanısıyla hastaneye yatan hastalarda kardiyo-metabolik komorbidite (KMK) sıklıklarının ve özelliklerinin belirlenmesi amaçladık.
Gereç ve Yöntem: Retrospektif, gözlemsel, klinik çalışmaya kovid-19 şüphesi ile hastaneye yatan 313 hastadan, polimeraz zincir reaksiyonu (PCR) ile konfirme kovid-19 tanısı olan 159 hasta alındı. KMK sıklıkları, hastaların özellikleri, yatış süreleri ve klinik sonlanımları (taburcu, exitus, YBÜ ihtiyacı) değerlendirildi.
Bulgular: Kovid-19 hastalarında; hipertansiyon, diabetes mellitus, hiperlipidemi, koroner arter hastalığı, kronik böbrek hastalığı, konjestif kalp yetersizliği ve serebrovasküler hastalık sıklıkları sırasıyla; %39, %24,5, %24,5, %20,1, %11,9, %9,4 ve %8,2 idi. En az 1 KMK olan 79 olgu (%49,1), ≥3 KMK olan 42 (%26,1) olgu vardı. Medyan yatış süresi dört gün, mortalite sıklığı %1,3, YBÜ ihtiyacı sıklığı %2,5 idi. Yaş arttıkça tüm KMK sıklıklarının anlamlı arttığı görüldü (tümü için p<0.05). PCR negatif olgulara göre PCR pozitif kovid-19 hastalarında ortalama yatış süresi (p=0,001) uzun, hipertansiyon sıklığı (p=0,008) düşüktü.
Sonuç: Hastaneye yatan kovid-19 hastalarında KMK sıklıklarının kovid-19 PCR negatif olgulara ve ulusal epidemiyolojik çalışmalardaki benzer yaş gruplarına göre yüksek bulunmadığı görülmüştür. Bununla birlikte yaklaşık her dört olgudan birinde, exitus olanların tümünde ve YBÜ ihtiyacı gelişenlerin yarısında çoklu KMK varlığı, KMK’lerin tek başlarına varlıklarından ziyade bir arada bulunmalarının Kovid-19 ile ilişkili klinik sonlanımlar üzerinde kümülatif bir risk artışına neden olduklarını düşündürmektedir.

Anahtar Kelimeler

Kovid-19, yatan hasta, kardiyo-metabolik komorbidite

The Frequency of Coexistent Cardio-metabolic Diseases in Covid-19 Patients and Their Effects On Clinical Outcomes

Öz

Aim: We aimed to determine the frequency and characteristics of cardio-metabolic comorbidities (CMC) in patients hospitalized with the diagnosis of COVID-19 disease.
Materials and Methods: In this retrospective study, 159 patients with a confirmed diagnosis of COVID-19 with polymerase chain reaction (PCR) were included out of 313 patients hospitalized with suspected COVID-19. CMC frequencies, patients characteristics, duration of hospitalizations, and clinical outcomes (discharge, death, ICU need) were determined.
Results: In COVID-19 patients, the frequencies of hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, chronic kidney disease, congestive heart failure, and cerebrovascular disease were 39%, 24.5%, 24.5%, 20.1%, 11.9%, 9.4%, and 8.2%, respectively. There were 79 cases (49.1%) with at least 1 CMC and 42 (26.1%) cases with ≥3 CMC. The median duration of hospitalization was four days, the mortality rate was 1.3%, and the frequency of ICU need was 2.5%. All CMC frequencies increased significantly with advancing age (p<0.05 for all). Compared to PCR negative cases, the mean duration of hospitalization (p=0.001) was longer, and the frequency of hypertension (p=0.008) was lower in PCR-positive COVID-19 patients.
Conclusions: Cardio-metabolic comorbidity frequencies in hospitalized COVID-19 patients were not higher than COVID-19 PCR negative cases and similar age groups without COVID-19 infection in national epidemiological studies. However, the presence of multiple CMCs were approximately one of every 4 cases, in all of those who died and in half of those who developed ICU needs, suggests that the coexistence of CMCs rather than their presence alone causes a cumulative risk increase on clinical outcomes associated with COVID-19.

Anahtar Kelimeler

COVID-19, inpatient, cardio-metabolic comorbidity

Kaynakça

• Referans1- Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8(5):475-81. doi: 10.1016/S2213-2600(20)30079-5.
• Referans2- Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382(18):1708-20. doi: 10.1056/NEJMoa2002032.
• Referans3- Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy 2020;75(7):1730-41. doi: 10.1111/all.14238.
• Referans4- Emami A, Javanmardi F, Pirbonyeh N, Akbari A. Prevalence of Underlying Diseases in Hospitalized Patients with COVID-19: a Systematic Review and Meta-Analysis. Arch Acad Emerg Med 2020;8(1):e35. eCollection 2020.
• Referans5- Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol 2020;109(5):531-8. doi: 10.1007/s00392-020-01626-9.
• Referans6- Madjid M, Safavi-Naeini P, Solomon SD, et al. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol 2020;5(7):831-40. doi: 10.1001/jamacardio.2020.1286.
• Referans7- Wang X, Fang X, Cai Z, et al. Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis. Research (Wash D C) 2020 Apr 19;2020:2402961. doi: 10.34133/2020/2402961.
• Referans8- Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020;323(13):1239-42. doi: 10.1001/jama.2020.2648.
• Referans9- World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance [Internet], 2020. [Cited 28 January 2020] Available from https://apps.who.int/iris/bitstream/handle/10665/330893/WHO-nCoV-Clinical-2020.3-eng.pdf?sequence51&isAllowed5y.
• Referans10- Sengul S, Akpolat T, Erdem Y, et al; Turkish Society of Hypertension and Renal Diseases. Changes in hypertension prevalence, awareness, treatment, and control rates in Turkey from 2003 to 2012. J Hypertens 2016;34:1208-17. doi: 10.1097/HJH.0000000000000901.
• Referans11- Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al; TURDEP-II Study Group. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013;28:169-80. doi: 10.1007/s10654-013-9771-9775.
• Referans12- Süleymanlar G, Utaş C, Arinsoy T, et al. A population-based survey of Chronic REnal Disease In Turkey--the CREDIT study. Nephrol Dial Transplant 2011;26(6):1862-71. doi: 10.1093/ndt/gfq656.
• Referans13- Goyal P, Choi JJ, Pinheiro LC, et al. Clinical Characteristics of Covid-19 in New York City. N Engl J Med 2020;382(24):2372-4. doi: 10.1056/NEJMc2010419.
• Referans14- Shi Q, Zhang X, Jiang F, et al. Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study. Diabetes Care 2020;43(7):1382-91. doi: 10.2337/dc20-0598.
• Referans15- Costa FF, Rosário WR, Ribeiro Farias AC, et al. Metabolic syndrome and COVID-19: An update on the associated comorbidities and proposed therapies. Diabetes Metab Syndr 2020;14(5):809-14. doi: 10.1016/j.dsx.2020.06.016.
• Referans16- Chocair PR, Neves PDMM, Pereira LVB, et al. Covid-19 and Metabolic Syndrome. Rev Assoc Med Bras (1992) 2020;66(7):871-5 doi: 10.1590/1806-9282.66.7.871.
• Referans17- Henry BM, de Oliveira MHS, Benoit S, et al. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med 2020 Jun 25;58(7):1021-8. doi: 10.1515/cclm-2020-0369.