Ege Üniversitesi Hastanesinde Başhekimlik Covid Gastroenteroloji ve Başhekimlik Covid Göğüs Hastalıkları Ünitesinde Covid-19 tanısı ile İzlenen hastaların retrospektif değerlendirmesi
Küçük Resim Yok
Dosyalar
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Global dünyanın son zamanlardaki en büyük salgını COVID-19, ilk defa Aralık 2019 da Çin de tanımlandı ve çok geçmeden Dünya Sağlık Örgütü tarafından, Mart 2020 de pandemi olarak kabul edildi. Ağırlıklı solunum yetmezliği olmak üzere, çoklu organ disfonkisyonu sebebiyle mortalitesi yüksek bu virüs aracılıklı hastalıkta patofizyolojisi üzerine çok çalışma, yorum ve tedavi protokolü için çok değişken seçenekler sunuldu. Hastalığın seyri ve kötüye gidişi ortaya koymak ve etkili tedavi yöntemini ortaya çıkarmak için mortalite belirteçleri üzerine çalışmalar yapıldı. Ancak halihazırda hala net olarak kabul görmüş tedavi protokolü geliştirilemedi. Bu çalışmamızda Ege Üniversitesi Başhekimlik Covid gastroenteroloji ve Başhekimlik Covid Göğüs Hastalıklarında COVİD-19 tanısıyla hastaneye yatırılarak izlenen hastaların retrospektif olarak demografik ve klinik verilerinin değerlendirilmesi ve mortalite predüktörlerinin belirlenmesi amaçlandı. Gereç ve Yöntem: Çalışmamız tek merkezli retrospektif bir çalışma olarak tasarlanmıştır. Çalışmaya 1 Kasım 2020-31 Mart 2022 tarihleri arasında Başhekimlik Covid Gastroenteroloji ve Başhekimlik Covid Göğüs servisinde yatmakta olan 441 COVID-19 tanılı hastaların demografik ve klinik özellikleri, laboratuvar parametreleri incelendi. Bu hastalardan bilgisayarlı tomografisinde COVID tutulumu olan ve Dünya Sağlık Örgütü sınıflamasına göre ciddi ve kritik hastalık tanımına uyan veya respratuvar disstres tanımına uyan 324 hasta dahil edildi. Hematolojik veya solid organ kanseri olmayan hasta alt grupları belirlendi ve onların mortalite belirteçleri incelendi. Bulgular: Çalışmamıza 324 hasta dahil edildi. Hastalarımızın 186’ sı erkek, 138’i kadındı. Yaş ortalamsı 60.74 saptandı. Hastaların demografik ve klinik özelliklerinin mortalite üzerine etkileri incelendiğinde ileri yaş, konjestif kalp yetmezliği, hematolojik kanser, izlemde gelişen akut böbrek yetmezliği, mekanik ventilatör desteğinde olması, non-invaziv mekanik ventilatör desteğinde olması mortaliteyi artırdığı anlamlı bulunmuştur (p<0.05). Hastaların geliş anındaki laktat yüksekliği, oksijen ihtiyacının fazla olması, SOFA skorunun yüksek olması CTnT, NTproBNP, CRP, ferritin, D-dimer, INR, NLR, MPV yüksekliği, albümin ve trombosit düşüklüğü mortalite predüktörü olarak anlamlı bulundu (p<0.05). Hastaların çıkış laboratuvar değerleri sonlanım, geliş laboratuvar değerleri başlangıç olarak değerlendirildi ve aradaki fark delta(Δ) değişim değeri olarak belirlendi ve bu farkın mortalite üzerine etkileri incelendi ve izlemde CTnT, NTproBNP, CRP, ferritin, INR, NLR, MPV değerlerinin artışı, trombosit, lenfosit ve albümin değerinin azalması mortalite predüktörü olarak anlamlı bulundu (p<0.05). Hastaların mortalite predüktörleri çok değişkenli regresyon analizi yapılarak incelendi ve OAB düşüşü trombosit düşüşü ve CRP yüksekliği çok değişkenli regresyon analizinde mortalite predüktörü açısından anlamlı bulundu ve mortaliteyi göstermede % 94.1 özgüllük ve %81.4 duyarlılığa sahipti. Sonuç: COVID-19 hastalarında CTnT, NTproBNP, CRP, ferritin, D-dimer, INR, NLR, MPV, albümin ve trombosit mortalite predüktörü olarak kullanılabilir.
Background & Aims: The largest recent outbreak in the global world, COVID-19, was first identified in China in December 2019 and was soon recognized as a pandemic by the World Health Organization in March 2020. In this virus-mediated disease with high mortality due to multi-organ dysfunction, mainly respiratory failure, multiple studies on the pathophysiology, interpretation and treatment protocol were presented. Studies were conducted on mortality markers to reveal the course and worsening of the disease and to reveal an effective treatment method. However, a clearly accepted treatment protocol has not been developed yet. In this study, it was aimed to retrospectively evaluate the demographic and clinical data of the patients hospitalized with the diagnosis of COVID-19 in Ege University Head Physician Covid gastroenterology and Head Physician Covid Chest Diseases, and to determine mortality predictors. Material & Methods: Our study was designed as a single-center retrospective study. The demographic and clinical characteristics and laboratory parameters of 441 patients with COVID-19 who were hospitalized in the Chief Physician Covid Gastroenterology and Chief Physician Covid Chest service between November 1, 2020 and March 31, 2022 were examined in the study. Among these patients, 324 patients who had COVID involvement in their computed tomography and met the definition of serious and critical illness according to the World Health Organization classification or met the definition of respiratory distress were included. Subgroups of patients without hematologic or solid organ cancer were identified and their mortality markers were examined. Results: Our study included 324 patients. 186 of our patients were male and 138 were female. The mean age was 60.74 years. When the effects of demographic and clinical characteristics of the patients on mortality were examined, it was found that advanced age, congestive heart failure, hematological cancer, acute renal failure developed during follow-up, being on mechanical ventilator support, and being on non-invasive mechanical ventilator support increased mortality (p<0.05). High lactate level, high oxygen demand, high SOFA score at the time of admission, CTnT, NTproBNP, CRP, ferritin, D-dimer, INR, NLR, MPV high, albumin and platelet low were found to be significant predictors of mortality (p<0.05). The exit laboratory values of the patients were evaluated as the endpoint, the admission laboratory values were evaluated as the baseline and the difference was determined as the delta(Δ) change value and the effects of this difference on mortality were examined. Decreased lymphocyte and albumin levels were found to be significant predictors of mortality (p<0.05). The mortality predictors of the patients were analyzed by multivariate regression analysis, and MAP decrease, platelet decrease and CRP elevation were found to be significant in terms of mortality predictor in multivariate regression analysis and had a specificity of 94.1% and a sensitivity of 81.4% in indicating mortality Conclusion: It can be used as a mortality predictor of CTnT, NTproBNP, CRP, ferritin, D-dimer, INR, NLR, MPV, albumin and platelet in COVID-19 patients.
Background & Aims: The largest recent outbreak in the global world, COVID-19, was first identified in China in December 2019 and was soon recognized as a pandemic by the World Health Organization in March 2020. In this virus-mediated disease with high mortality due to multi-organ dysfunction, mainly respiratory failure, multiple studies on the pathophysiology, interpretation and treatment protocol were presented. Studies were conducted on mortality markers to reveal the course and worsening of the disease and to reveal an effective treatment method. However, a clearly accepted treatment protocol has not been developed yet. In this study, it was aimed to retrospectively evaluate the demographic and clinical data of the patients hospitalized with the diagnosis of COVID-19 in Ege University Head Physician Covid gastroenterology and Head Physician Covid Chest Diseases, and to determine mortality predictors. Material & Methods: Our study was designed as a single-center retrospective study. The demographic and clinical characteristics and laboratory parameters of 441 patients with COVID-19 who were hospitalized in the Chief Physician Covid Gastroenterology and Chief Physician Covid Chest service between November 1, 2020 and March 31, 2022 were examined in the study. Among these patients, 324 patients who had COVID involvement in their computed tomography and met the definition of serious and critical illness according to the World Health Organization classification or met the definition of respiratory distress were included. Subgroups of patients without hematologic or solid organ cancer were identified and their mortality markers were examined. Results: Our study included 324 patients. 186 of our patients were male and 138 were female. The mean age was 60.74 years. When the effects of demographic and clinical characteristics of the patients on mortality were examined, it was found that advanced age, congestive heart failure, hematological cancer, acute renal failure developed during follow-up, being on mechanical ventilator support, and being on non-invasive mechanical ventilator support increased mortality (p<0.05). High lactate level, high oxygen demand, high SOFA score at the time of admission, CTnT, NTproBNP, CRP, ferritin, D-dimer, INR, NLR, MPV high, albumin and platelet low were found to be significant predictors of mortality (p<0.05). The exit laboratory values of the patients were evaluated as the endpoint, the admission laboratory values were evaluated as the baseline and the difference was determined as the delta(Δ) change value and the effects of this difference on mortality were examined. Decreased lymphocyte and albumin levels were found to be significant predictors of mortality (p<0.05). The mortality predictors of the patients were analyzed by multivariate regression analysis, and MAP decrease, platelet decrease and CRP elevation were found to be significant in terms of mortality predictor in multivariate regression analysis and had a specificity of 94.1% and a sensitivity of 81.4% in indicating mortality Conclusion: It can be used as a mortality predictor of CTnT, NTproBNP, CRP, ferritin, D-dimer, INR, NLR, MPV, albumin and platelet in COVID-19 patients.
Açıklama
Anahtar Kelimeler
COVID-19, Mortalite Belirteçleri, Nötrofil Lenfosit Oranı, Ferritin, COVID-19, Mortality Markers, Neutrophil Lymphocyte Ratio, Ferritin
