The difference in mortality between COVID-19 and non-COVID-19 malign intensive care patients?

Öz

Aim: The aim of this study is to compare the demographic, clinical, laboratory characteristics and mortality rates of malignant patients followed in the COVID-19 and non-COVID-19 intensive care units (ICU) during the pandemic. Material and Methods: This is a retrospective observational study that included patients with oncological diagnosis of COVID-19 and non-COVID-19 hospitalized in the ICU between March 23, 2020 - January 31, 2022. Adult patients (≥18 years), with hematological or solid organ malignancy were included in this study. Patients were divided into two groups; first group admitted to ICU with the diagnosis of COVID-19 (polymerase chain reaction (PCR) test positive) and second gropu admitted to ICU without the diagnosis of COVID-19 (PCR test negative and clinically and radiologically confirmed that they were not COVID-19). Data of two groups were compared. Results: A total of 283 patients, 150 of whom had malignancies with COVID-19, and 133 patients with malignancies with non-COVID-19 were included in the study. When the malignancy characteristics of the two groups were compared; cured malignancy was significantly higher in the COVID-19 group. The rates of patients with solid organ malignancies were statistically higher in the COVID-19 group (85.3%), while those with hematological malignancies (24.1%) were statistically higher in the non-COVID-19 group (p=0.04 and 0.03, respectively). In addition, lung carcinoma (22%) was statistically significantly higher in the COVID-19 group. Predictors of mortality were invasive mechanical ventilator (IMV) requirement, duration of IMV, concomitant neurologic disease and need of vasopressor/inotrope. Conclusion: It was concluded that the mortality rate in COVID-19 malignant patients was lower than that of non-COVID-19 malignant patients, and that requirement and duration of IMV, the need of vasopessor/inotrope, and concomitant neurological disease were effective in mortality in all malignant patients. We think that the higher mortality in the nonCOVID-19 patient group may be due to factors such as end stage of the malignancy, clinical course, and immunosuppressive treatment (radiotherapy, chemotherapy, etc.).

Anahtar Kelimeler

• COVID-19
• non-COVID-19
• malignancy
• oncological patients
• mortality
• mortality predictors

Yoğun bakımdaki COVID-19 malign ve nonCOVID-19 malign hastalarda mortalite farklı mıdır?

Öz

Amaç: Bu çalışmanın amacı, pandemi süresince COVID-19 ve non-COVID-19 yoğun bakım ünitelerinde (YBÜ) takip edilen malign hastaların demografik, klinik, laboratuvar özelliklerini ve mortalite oranlarını karşılaştırmaktır. Gereç ve Yöntemler: Bu çalışma 23 Mart 2020- 31 Ocak 2022 tarihleri arasında COVID-19 ve non-COVID-19 YBÜ’de yatan onkolojik tanılı hastaların dahil edildiği retrospektif gözlemsel çalışmadır. Erişkin (≥18 yaş), hematolojik ya da solid organ malignitesi olan hastalar çalışmaya alındı. Hastalar iki gruba ayrıldı: Birinci grup COVID-19 tanısı (Polimerase chain reaction (PCR) testi pozitif) ile COVID-19 YBÜ’ne kabul edilen, ikinci grup ise COVID-19 tanısı dışlanarak (PCR testi negatif ve klinik ve radyolojik olarak COVID-19 olmadığı doğrulanan) non-COVID-19 YBÜ’ne kabul edilen hastalar oluşturdu. İki grubun verileri karşılaştırıldı. Bulgular: Çalışmaya 150 COVID-19 ve malignitesi olan, 133 non-COVID-19 ve malignitesi olan toplam 283 hasta dahil edildi. İki grubun malignite özellikleri karşılaştırıldığında; COVID-19 grubunda malignitede kür sağlananlar anlamlı olarak fazlaydı. Solid organ malignitesi olanların oranları COVID-19 grubunda (%85,3), hematolojik malignitesi olanların oranı (%24,1) ise non-COVID-19 grubunda istatistiksel farkla daha fazlaydı (sırasıyla, p=0.04 ve 0.03). Ayrıca akciğer karsinomu (%22) COVID-19 grubunda istatistiksel olarak anlamlı olarak fazla idi. Tüm malign hastalarda mortalite prediktörü olarak; invaziv mekanik ventilatör (IMV) ihtiyacı, IMV kalış süresinde artış, nörolojik hastalığın eşlik etmesi ve vazopressör/inotrop ihtiyacı olarak belirlendi. Sonuç: COVID-19 malign hastalarda mortalite oranının non-COVID-19 malign hastalardan daha düşük olduğu, tüm malign hastalarda mortaliteye IMV gereksinimi ve süresi, vazopessör/inotrop ihtiyacı ve nörolojik hastalığın eşlik etmesinin etkili olduğu sonucuna varıldı. Mortalitenin non-COVID-19 hasta grubunda daha fazla olmasını malignitenin ileri evresi, klinik seyri, uygulanan immunsuprese tedavi (radyoterapi, kemoterapi gibi) gibi faktörlere bağlı olabileceğini düşünüyoruz.

Anahtar Kelimeler

• COVID-19
• nonCOVID-19
• malignite
• onkolojik hastalar
• mortalite
• mortalite prediktörleri

Kaynakça

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