TÜRKİYE‘DE COVID-19 İLE ENFEKTE OLAN SOLİD ORGAN NAKİLLİ HASTALARIN ACİL SERVİS VE HASTANE BAŞVURULARININ İNCELENMESİ

Yıl 2021, Sayı: 18, 67 - 81, 30.12.2021

Hayri Canbaz , Attila Beştemir , Aziz Surel , Bülent Aydınlı Erdal Yekeler Uluğ Eldegez Serap Aykut Aka

https://doi.org/10.46218/tshd.1020720

Cited By: 3

Öz

Giriş: COVID-19 pandemisinde hastalık, insandan insana bulaşma özelliği nedeniyle aile ve toplum yaşamını olumsuz etkilemiş, hızla yayılarak Acil Servis başvurularında aşırı bir artış oluşturmuştur. Transplantasyon yapılan hastalar gibi hassas hastaların bakımı da zor bir hal almıştır. Hem aile içindeki bulaş hem de toplum içindeki bulaş nedeniyle Acil Servislerde bu hassas hastaların bakımı, değerlendirilmesi, acil tanısı ve yatış kararı kritik öneme haizdir. Bu çalışmada amacımız; Acil servis başvurularının arttığı Covid-19 enfeksiyonu sürecinde Türkiye’de Solid organ nakilli hastaların başvuru sonuçlarının incelenmesidir.
Metod: Girişimsel olmayan retrospektif gözlemsel dizayn edilen bu çalışmada; Mart 2020-Ocak 2021 tarihleri arasında Türkiye’de Covid-19 şüphesiyle hastaneye başvuran solid organ nakilli kişiler dahil edilmiştir. 14.463 olgunun Sağlık Bakanlığı bilgi sistemlerine kaydedilmiş klinik ve radyolojik parametreleri, servis ve yoğun bakım yatış ihtiyacı, yatış süreleri ve ölüm oranları incelenmiştir.
Bulgular: Olguların %70,39’u (10.180) böbrek nakilli kişiler, %22’si (3245) karaciğer nakilli kişiler, %4,98’i (721) kalp nakli olmuş kişiler, %1,85’i (262) akciğer nakilliler, %0,21’ü (30) ince barsak nakilliler, %0,17’si (25) pankreas nakli olmuş kişilerden oluşuyordu. Tüm solid organ nakilli hastaların ortalama yatış oranı %86,7 idi. Solid organ nakilli hastalar değerlendirildiğinde COVID-19 tanısı konan 4307 hastanın %40,9’unda (1765) pnömoni saptandı, 1691’i (%39,2) hastaneye yatırılırken bu süre ortalama 10,08 gün idi. Yaş ortalamaları ise 48,83 ‘dü. Yoğun bakıma 448 (%10,4) vaka yatırıldı ve kalış süreleri 8,41 gün, ortalama yaşlarının da 57,4 ‘dü. COVID-19 tanısı alıp entübe olan solid organ nakilli hasta oranı %4,3 olup yatış süresi ortalama 7,6 gündü. Solid organ nakli olan tüm vakalarda toplam ölüm sayısı 318 (%2,19), ölenlerin yaş ortalaması 59,64 ‘du. COVID-19 tanısı almış tüm solid organ nakilli hastalarda ölüm oranı ise %7,38 olarak bulundu.
Sonuç: COVID-19 pandemisi tibbi sosyal hizmetleri zorlaştırdığı göz önüne alındığında; Acil servislerde Solid organ nakli olan hastalar gibi hassas grupları izole etmenin, hızlı bir şekilde tanı ve yatış-taburcu kararı vermenin önemini ortaya koymaktadır. . Bu kararın; hem COVID-19 enfeksiyonunun sosyal hayatta hassas gruplarda yayılmasını azaltmada hem de enfeksiyon sonrası gelişebilecek pnömoni ve ötesi mortalitenin azaltılmasına katkı sağladığını, acil servislerde sosyal hizmet uygulamasının daha etkin olması için yeni önerilere ihtiyaç olduğunu düşünüyoruz.

Anahtar Kelimeler

Acil servis, Tıbbi hizmet, Solid Organ nakilleri, covid-19, mortalite

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

Kıymetli katkılarından dolayı Doku, Organ Nakli ve Diyaliz Hizmetleri Daire Başkanı Dr. Fatih KACIROĞLU ve Birim Sorumlusu Seher TAŞ ‘a sonsuz teşekkür eder, saygılar sunarız.

INVESTIGATION OF EMERGENCY SERVICE AND HOSPITAL APPLICATIONS OF SOLID ORGAN TRANSPLANT PATIENTS INFECTED WITH COVID-19 IN TURKEY

Öz

Introduction: In the COVID-19 pandemic, the disease adversely affected family and community life due to its human-to-human transmission feature, spreading rapidly and creating an excessive increase in Emergency Service applications. Caring for sensitive patients, such as transplant patients, has also become difficult. Due to both family and community transmission, the care, evaluation, emergency diagnosis and hospitalization decision of these vulnerable patients are critical in the Emergency Departments. Our aim in this study is to examine the application results of solid organ transplant patients in Turkey during the Covid-19 infection period while emergency service applications are increasing.Method: In this non-invasive retrospective observational study; Between March 2020 and January 2021, solid organ transplant patients who applied to the hospital with the suspicion of Covid-19 in Turkey were included. The clinical and radiological parameters of 14,463 cases recorded in the information systems of the Ministry of Health, the need for hospitalization in the service and intensive care unit, length of stay and mortality rates were examined.
Result: 70.39% (10.180) of the cases were kidney transplant recipients, 22% (3245) were liver transplant recipients, 4.98% (721) were heart transplant recipients, 1.85% (262) were lung transplant recipients , 0.21% (30) were small bowel transplant recipients, 0.17% (25) were pancreatic transplant recipients. The mean hospitalization rate of all solid organ transplant patients was 86.7%. When solid organ transplant patients were evaluated, pneumonia was detected in 40.9% (1765) of 4307 patients diagnosed with COVID-19, 1691 (39.2%) were hospitalized, with an average of 10.08 days. The mean age was 48.83. 448 (10.4%) cases were hospitalized in the intensive care unit, and their length of stay was 8.41 days and their mean age was 57.4 years. The rate of solid organ transplant patients diagnosed with COVID-19 and intubated was 4.3%, and the average length of stay was 7.6 days. The total number of deaths in all cases with solid organ transplantation was 318 (2.19%), and the mean age of those who died was 59.64 years. The mortality rate in all solid organ transplant patients diagnosed with COVID-19 was 7.38%.
Conclusion: Considering that the COVID-19 pandemic complicates medical social services; It demonstrates the importance of isolating vulnerable groups such as patients with solid organ transplants in emergency departments and making a rapid diagnosis and hospitalization-discharge decision. We think that it contributes to both reducing the spread of COVID-19 infection in vulnerable groups in social life and reducing the post-infection pneumonia and beyond mortality, and that new recommendations are needed for more effective social work practice in emergency services.

Anahtar Kelimeler

Emergency service, Covid-19, mortality, Medical service, Solid Organ transplants

Proje Numarası

yok

Kaynakça

• 1. World Health Organization Coronavirus disease (COVID-19) pandemic. Access date 01 Jan 2021, https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• 2. Caillard, S., Chavarot, N., Francois, H., Matignon, M., Greze, C., Kamar, N., ... & French SOT COVID Registry. (2021). Is Covid‐19 infection more severe in kidney transplant recipients?. American Journal of Transplantation, 21(3), 1295-1303. Doi: 10.1111/ajt.16424.
• 3. Lubetzky, M., Aull, M. J., Craig-Schapiro, R., Lee, J. R., Marku-Podvorica, J., Salinas, T., ... & Dadhania, D. M. (2020). Kidney allograft recipients, immunosuppression, and coronavirus disease-2019: a report of consecutive cases from a New York City transplant center. Nephrology Dialysis Transplantation, 35(7), 1250-1261. doi: 10.1093/ndt/gfaa154.
• 4. Banerjee, D., Popoola, J., Shah, S., Ster, I. C., Quan, V., & Phanish, M. (2020). COVID-19 infection in kidney transplant recipients. Kidney international, 97(6), 1076-1082.. doi: 10.1016/j.kint.2020.03.018.
• 5. Chen, T. Y., Farghaly, S., Cham, S., Tatem, L. L., Sin, J. H., Rauda, R., ... & Sumrani, N. (2020). COVID‐19 pneumonia in kidney transplant recipients: Focus on immunosuppression management. Transplant Infectious Disease, 22(5), e13378. doi: 10.1111/tid.13378.
• 6. Shingare, A., Bahadur, M. M., & Raina, S. (2020). COVID‐19 in recent kidney transplant recipients. American Journal of Transplantation, 20(11), 3206-3209. doi: 10.1111/ajt.16120.
• 7. Chaudhry, Z. S., Williams, J. D., Vahia, A., Fadel, R., Parraga Acosta, T., Prashar, R., ... & Alangaden, G. J. (2020). Clinical characteristics and outcomes of COVID‐19 in solid organ transplant recipients: a cohort study. American Journal of Transplantation, 20(11), 3051-3060. doi: 10.1111/ajt.16188.
• 8. Sağlık Bakanlığı Doku, Organ Nakli ve Diyaliz Hizmetleri Dairesi Başkanlığı TTDİS Sistemleri Kamuoyu Aydınlatma Platformu. Erişim tarihi 01 Temmuz 2021, https://organkds.saglik.gov.tr/dss/Default.aspx
• 9. Grifoni, A., Weiskopf, D., Ramirez, S. I., Mateus, J., Dan, J. M., Moderbacher, C. R., ... & Sette, A. (2020). Targets of T cell responses to SARS-CoV-2 coronavirus in humans with COVID-19 disease and unexposed individuals. Cell, 181(7), 1489-1501. doi: 10.1016/j.cell.2020.05.015
• 10. Cravedi, P., Mothi, S. S., Azzi, Y., Haverly, M., Farouk, S. S., Pérez‐Sáez, M. J., ... & Riella, L. V. (2020). COVID‐19 and kidney transplantation: results from the TANGO International Transplant Consortium. American Journal of Transplantation, 20(11), 3140-3148. doi:10.1111/ ajt.16185
• 11. Akalin, E., Azzi, Y., Bartash, R., Seethamraju, H., Parides, M., Hemmige, V., ... & Kinkhabwala, M. (2020). Covid-19 and kidney transplantation. New England Journal of Medicine, 382(25), 2475-2477. Doi: 10.1056/NEJMc2011117
• 12. Zhu, L., Gong, N., Liu, B., Lu, X., Chen, D., Chen, S., ... & Chen, Z. (2020). Coronavirus disease 2019 pneumonia in immunosuppressed renal transplant recipients: a summary of 10 confirmed cases in Wuhan, China. European urology, 77(6), 748-754. doi: 10.1016/j.eururo.2020.03.039
• 13. Columbia University Kidney Transplant Program. (2020). Early description of coronavirus 2019 disease in kidney transplant recipients in New York. Journal of the American Society of Nephrology, 31(6), 1150-1156. doi: 10.1681/ASN.2020030375
• 14. Alberici, F., Delbarba, E., Manenti, C., Econimo, L., Valerio, F., Pola, A., ... & Scolari, F. (2020). A report from the Brescia Renal COVID Task Force on the clinical characteristics and short-term outcome of hemodialysis patients with SARS-CoV-2 infection. Kidney international, 98(1), 20-26. doi: 10.1016/j.kint.2020.04.030
• 15. Caillard, S., Anglicheau, D., Matignon, M., Durrbach, A., Greze, C., Frimat, L., ... & Saliba, F. (2020). An initial report from the French SOT COVID Registry suggests high mortality due to Covid-19 in recipients of kidney transplants. Kidney international, 98(6), 1549-1558. doi:10.1016/j.kint.2020.08.005
• 16. Benotmane, I., Perrin, P., Vargas, G. G., Bassand, X., Keller, N., Lavaux, T., ... & Caillard, S. (2021). Biomarkers of cytokine release syndrome predict disease severity and mortality from COVID-19 in kidney transplant recipients. Transplantation, 105(1), 158-169. doi:10.1097/TP.000000000 0003480
• 17. Kates, O. S., Haydel, B. M., Florman, S. S., Rana, M. M., Chaudhry, Z. S., Ramesh, M. S., ... & Limaye, A. P. (2020). COVID-19 in solid organ transplant: a multi-center cohort study. Clinical infectious diseases. doi:10.1093/cid/ciaa1097
• 18. Chaudhry, Z. S., Williams, J. D., Vahia, A., Fadel, R., Parraga Acosta, T., Prashar, R., ... & Alangaden, G. J. (2020). Clinical characteristics and outcomes of COVID‐19 in solid organ transplant recipients: a cohort study. American Journal of Transplantation, 20(11), 3051-3060. doi:10.1111/ajt.16188
• 19. Yi, S. G., Rogers, A. W., & Saharia, A. Early experience with COVID-19 and solid organ transplantation at a US high-volume transplant center [e-pub ahead of print]. Transplantation doi : 10.1097/TP, 3339.
• 20. Felldin, M., Søfteland, J. M., Magnusson, J., Ekberg, J., Karason, K., Schult, A., ... & Friman, V. (2021). Initial report from a Swedish high-volume transplant center after the first wave of the COVID-19 pandemic. Transplantation, 105(1), 108-114. doi:10.1097/TP.0000000000003436
• 21. Pereira, M. R., Mohan, S., Cohen, D. J., Husain, S. A., Dube, G. K., Ratner, L. E., ... & Verna, E. C. (2020). COVID‐19 in solid organ transplant recipients: initial report from the US epicenter. American journal of transplantation, 20(7), 1800-1808. doi: 10.1111/ajt.15941
• 22. Bossini, N., Alberici, F., Delbarba, E., Valerio, F., Manenti, C., Possenti, S., ... & Brescia Renal COVID task force. (2020). Kidney transplant patients with SARS‐CoV‐2 infection: the Brescia renal COVID Task force experience. American Journal of Transplantation, 20(11), 3019-3029. doi:10.1111/ajt.16176
• 23. Miarons, M., Larrosa-García, M., García-García, S., Los-Arcos, I., Moreso, F., Berastegui, C., ... & Gorgas-Torner, M. Q. (2021). COVID-19 in solid organ transplantation: a matched retrospective cohort study and evaluation of immunosuppression management. Transplantation, 105(1), 138-150. doi:10.1097/ TP.0000000000003460
• 24. Malekhosseini, S. A., Nikoupour, H., Gholami, S., Shamsaeefar, A., Arasteh, P., Kazemi, K., ... & Nikeghbalian, S. (2021). A report of 85 cases of COVID-19 and abdominal transplantation from a single center: what are the associated factors with death among organ transplantation patients. Transplantation, 105(1), 90-99. doi: 10.1097/TP.0000000000003470
• 25. Webb, G. J., Marjot, T., Cook, J. A., Aloman, C., Armstrong, M. J., Brenner, E. J., ... & Moon, A. M. (2020). Outcomes following SARS-CoV-2 infection in liver transplant recipients: an international registry study. The lancet Gastroenterology & hepatology, 5(11), 1008-1016. doi: 10.1016/S2468-1253(20)30271-5
• 26. Becchetti, C., Zambelli, M. F., Pasulo, L., Donato, M. F., Invernizzi, F., Detry, O., ... & Dufour, J. F. (2020). COVID-19 in an international European liver transplant recipient cohort. Gut, 69(10), 1832-1840. doi: 10.1136/gutjnl-2020-321923
• 27. Latif, F., Farr, M. A., Clerkin, K. J., Habal, M. V., Takeda, K., Naka, Y., ... & Uriel, N. (2020). Characteristics and outcomes of recipients of heart transplant with coronavirus disease 2019. JAMA cardiology, 5(10), 1165-1169. doi:10.1001/jamacardio.2020.2159