Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul
Yıl: 2021 Cilt: 17 Sayı: 1 Sayfa Aralığı: 100 - 107 Metin Dili: İngilizce DOI: 10.5222/BMJ.2021.77200 İndeks Tarihi: 20-05-2021
Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul
Öz: Objective: In late 2019, the Coronavirus disease 2019 (COVID-19) has been pandemic worldwide, starting in Wuhan, China. In this study, we aimed to evaluate the factors associated with 28-day outcomes in patients admitted to the intensive care unit with the diagnosis of COVID-19.Method: This study has a retrospective cohort design. COVID-19 patients identified according to World Health Organization guidelines are included. Patient data were recorded to a centralized system utilizing ImdSoft-Meta vision/QlinICU Clinical Decision Support Software. Individual datasets about required parameters were obtained from Structured Query Language (SQL) queries. The main laboratory parameters were examined. SOFA, APACHE II, and Charlson Comorbidity Score (CCS) were calculated. In evaluating laboratory parameters and disease risk scores, which are thought to affect 28-day mortality, logistic analysis were performed using the Backward LR model.Results: The study was carried out with 101 patients, 40 (39.6%) of whom were women, and 61 (60.4%) of men, who met the inclusion criteria. The ages of the patients ranged from 21 to 88, and the mean age was 58.45 ± 15.41 years. The mean intensive care hospitalization period was 12.5 ± 10.2 days. The all-cause in-hospital mortality rate was 61.4%. Leukocyte count, CK, NT-proBNP, PCT, CRP, ferritin, neutrophil count and percentage, D-Dimer, LDH, AST values were found to be significantly higher in non-survivors. The lymphocyte count and percentage, and platelet count values were found to be significantly low in non-survivors. The lymphocyte percentage, LDH, and CCS were significant in the 28-day mortality in multivariate analysis (p values are 0.01, 0.003, 0.008, respectively).Conclusion: High lymphocyte values have been found to significantly reduce the risk of death in patients diagnosed with COVID-19. Lymphocyte percentage, LDH, and CCS were evaluated as the most successful parameters in predicting 28-day mortality in the intensive care unit.
Anahtar Kelime: İstanbul'daki Üçüncü Basamak bir Merkezin Yoğun Bakım Ünitesindeki COVID-19 Hastalarında 28 Günlük Mortalite için Risk Faktörleri
Öz: Amaç: 2019 sonlarında, Çin'in Hubei eyaletinin Wuhan şehrinde başlayıp 2020 yılının ilk altı ayında tüm Dünyada Covid-19 pandemisi salgın olarak yaşanmaktadır. Bu çalışmada, yoğun bakım ünitesine COVID-19 tanısıyla başvuran hastalarda 28 günlük sonuçlarla ilişkili faktörlerin değerlendirilmesi amaçlanmıştır.Yöntem: Bu çalışma retrospektif kohort olarak tasarlandı. Dünya Sağlık Örgütü kılavuzlarına göre tanımlanan COVID-19 hastaları hastalar çalışmaya dahil edildi. Hasta verileri, ImdSoft-Meta vision / QlinICU Clinical Decision Support Software kullanılarak merkezi bir sisteme kaydedildi. Structured Query Language (SQL) sorgularından gerekli parametrelerle ilgili bireysel veri kümeleri elde edildi. Ana laboratuvar parametreleri incelendi. SOFA, APACHE II ve Charlson Komorbidite Skoru (CCS) hesaplandı. 28 günlük mortaliteyi etkilediği düşünülen laboratuvar parametreleri ve hastalık risk skorlarının değerlendirilmesinde Backward LR modeli kullanılarak lojistik analiz yapıldı.Bulgular: Çalışma, dahil edilme kriterlerini karşılayan 40'ı (% 39,6) kadın ve 61'i (% 60,4) erkek olmak üzere 101 hasta ile gerçekleştirildi. Hastaların yaşları 21 ile 88 arasında değişmekte olup, ortalama yaş 58,45 ± 15,41 yıldı. Ortalama yoğun bakıma yatış süresi 12,5 ± 10,2 gündü. Tüm nedenlere bağlı hastane içi ölüm oranı% 61,4'tü. Hayatta kalmayanlarda lökosit sayısı, CK, NT-proBNP, PCT, CRP, ferritin, nötrofil sayısı ve yüzdesi, D-Dimer, LDH, AST değerleri anlamlı olarak yüksek bulundu. Hayatta kalmayanlarda lenfosit sayısı ve yüzdesi ile trombosit sayısı değerleri anlamlı olarak düşük bulundu. Lenfosit yüzdesi, LDH ve CCS, çok değişkenli analizde 28 günlük mortalitede anlamlıydı (p değerleri sırasıyla 0,01, 0,003, 0,008'dir).Sonuçlar: Yüksek lenfosit değerlerinin COVID-19 teşhisi konan hastalarda ölüm riskini önemli ölçüde azalttığı görüldü. Yoğun bakım ünitesinde 28 günlük mortaliteyi öngörmede en başarılı parametreler lenfosit yüzdesi, LDH ve CCS olarak değerlendirildi.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020 Mar 26;382(13):1199-1207.
- 2. Mo P, Xing Y, Xiao Y, Deng L, Zhao Q, Wang H, et al. Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clin Infect Dis. 2020 Mar 16:ciaa270. https://doi.org/10.1093/cid/ciaa270
- 3. WHO Rolling updates on coronavirus disease (COVID-19) https://www.who.int/emergencies/diseases/novel-coronavirus-2019
- 4. Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA. 2020 May 12;323(18): 1775-6. https://doi.org/10.1001/jama.2020.4683
- 5. CDC COVID-19 Response Team, CDC COVID-19 Response Team, Bialek S, Boundy E, Bowen V, Chow N, vd. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020 Mar 27;69(12):343-6. https://doi.org/10.15585/mmwr.mm6912e2
- 6. Baud D, Qi X, Nielsen-Saines K, Musso D, Pomar L, Favre G. Real estimates of mortality following COVID-19 infection. Lancet Infect Dis. 2020 Jul;20(7):773. https://doi.org/10.1016/S1473-3099(20)30195-X
- 7. Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, Aaron JG, Claassen J, Rabbani LE, Hastie J, Hochman BR, Salazar-Schicchi J, Yip NH, Brodie D, O'Donnell MR. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020 Jun 6;395(10239):1763-1770. https://doi.org/10.1016/S0140-6736(20)31189-2
- 8. Chen R, Sang L, Jiang M, Yang Z, Jia N, Fu W, Xie J, Guan W, Liang W, Ni Z, Hu Y, Liu L, Shan H, Lei C, Peng Y, Wei L, Liu Y, Hu Y, Peng P, Wang J, Liu J, Chen Z, Li G, Zheng Z, Qiu S, Luo J, Ye C, Zhu S, Zheng J, Zhang N, Li Y, He J, Li J, Li S, Zhong N; Medical Treatment Expert Group for COVID-19. Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China. J Allergy Clin Immunol. 2020 Jul;146(1):89-100. https://doi.org/10.1016/j.jaci.2020.05.003
- 9. Elshazli RM, Toraih EA, Elgaml A, El-Mowafy M, El-Mesery M, Amin MN, Hussein MH, Killackey MT, Fawzy MS, Kandil E. Diagnostic and prognostic value of hematological and immunological markers in COVID-19 infection: A meta-analysis of 6320 patients. PLoS One. 2020 Aug 21;15(8):e0238160. https://doi.org/10.1371/journal.pone.0238160
- 10. Republic of Turkey Ministry of Health. COVID-19 Guideline. [23 July 2020]; Available from: https://covid19bilgi.saglik.gov.tr/tr/covid-19-rehberi.html.
- 11. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323(11):1061-1069. https://doi.org/10.1001/jama.2020.1585
- 12. Matsumoto H, Kasai T, Sato A, Ishiwata S, Yatsu S, Shitara J, Murata A, Kato T, Suda S, Matsue Y, Hiki M, Takagi A, Daida H. Association between C-reactive protein levels at hospital admission and long-term mortality in patients with acute decompensated heart failure. Heart Vessels. 2019 Dec;34(12):1961-1968. https://doi.org/10.1007/s00380-019-01435-9
- 13. Chalmers S, Khawaja A, Wieruszewski PM, Gajic O, Odeyemi Y. Diagnosis and treatment of acute pulmonary inflammation in critically ill patients: The role of inflammatory biomarkers. World J Crit Care Med. 2019 Sep 11;8(5):59-71. https://doi.org/10.5492/wjccm.v8.i5.74
- 14. Deng Y, Liu W, Liu K, Fang YY, Shang J, Zhou L, Wang K, Leng F, Wei S, Chen L, Liu HG. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 in Wuhan, China: a retrospective study. Chin Med J (Engl). 2020 Jun 5;133(11):1261-1267. https://doi.org/10.1097/CM9.0000000000000824
- 15. Debuc B, Smadja DM. Is COVID-19 a New Hematologic Disease? Stem Cell Rev Rep. 2020 May 12:1-5. https://doi.org/10.1007/s12015-020-09987-4
- 16. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-1720. https://doi.org/10.1101/2020.02.06.20020974
- 17. Lu J, Wei Z, Jiang H, Cheng L, Chen Q, Chen M, Yan J, Sun Z. Lactate dehydrogenase is associated with 28-day mortality in patients with sepsis: a retrospective observational study. J Surg Res. 2018 Aug;228:314-321. https://doi.org/10.1016/j.jss.2018.03.035
- 18. Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, Zhang Z. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. 2020 Jun;18(6):1324-1329. doi: 10.1111/jth.14859. https://doi.org/10.1111/jth.14859
- 19. Mucha SR, Dugar S, McCrae K, Joseph D, Bartholomew J, Sacha GL, Militello M. Coagulopathy in COVID-19: Manifestations and management. Cleve Clin J Med. 2020 Jul 31;87(8):461-468. https://doi.org/10.3949/ccjm.87a.ccc024
- 20. Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. 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):1021-1028. https://doi.org/10.1515/cclm-2020-0369
- 21. Akpınar EE, Hoşgün D, Akpınar S, Ateş C, Baha A, Gülensoy ES, Ogan N. Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneumonia? J Bras Pneumol. 2019 Aug 12;45(4):e20180417. https://doi.org/10.1590/1806-3713/e20180417
- 22. Gao L, Jiang D, Wen XS, Cheng XC, Sun M, He B, You LN, Lei P, Tan XW, Qin S, Cai GQ, Zhang DY. Prognostic value of NT-proBNP in patients with severe COVID-19. Respir Res. 2020 Apr 15;21(1):83. https://doi.org/10.1186/s12931-020-01352-w
- 23. Yuan J, Zou R, Zeng L, Kou S, Lan J, Li X, Liang Y, Ding X, Tan G, Tang S, Liu L, Liu Y, Pan Y, Wang Z. The correlation between viral clearance and biochemical outcomes of 94 COVID-19 infected discharged patients. Inflamm Res. 2020 Jun;69(6):599-606. https://doi.org/10.1007/s00011-020-01342-0
- 24. Tuty Kuswardhani RA, Henrina J, Pranata R, Anthonius Lim M, Lawrensia S, Suastika K. Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and meta-analysis. Diabetes Metab Syndr. 2020;14(6):2103-2109.
- 25. Iaccarino G, Grassi G, Borghi C, Ferri C, Salvetti M, Volpe M, et al. Age and Multimorbidity Predict Death Among COVID-19 Patients: Results of the SARS-RAS Study of the Italian Society of Hypertension. Hypertension. 2020;76(2):366-372.
| APA | EROL A, Aşar S, OREN BILGIN B, Çukurova Z, Sabaz M (2021). Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul. , 100 - 107. 10.5222/BMJ.2021.77200 |
| Chicago | EROL Ahmet Tolga,Aşar Sinan,OREN BILGIN Beyza,Çukurova Zafer,Sabaz Mehmet Süleyman Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul. (2021): 100 - 107. 10.5222/BMJ.2021.77200 |
| MLA | EROL Ahmet Tolga,Aşar Sinan,OREN BILGIN Beyza,Çukurova Zafer,Sabaz Mehmet Süleyman Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul. , 2021, ss.100 - 107. 10.5222/BMJ.2021.77200 |
| AMA | EROL A,Aşar S,OREN BILGIN B,Çukurova Z,Sabaz M Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul. . 2021; 100 - 107. 10.5222/BMJ.2021.77200 |
| Vancouver | EROL A,Aşar S,OREN BILGIN B,Çukurova Z,Sabaz M Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul. . 2021; 100 - 107. 10.5222/BMJ.2021.77200 |
| IEEE | EROL A,Aşar S,OREN BILGIN B,Çukurova Z,Sabaz M "Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul." , ss.100 - 107, 2021. 10.5222/BMJ.2021.77200 |
| ISNAD | EROL, Ahmet Tolga vd. "Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul". (2021), 100-107. https://doi.org/10.5222/BMJ.2021.77200 |
| APA | EROL A, Aşar S, OREN BILGIN B, Çukurova Z, Sabaz M (2021). Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul. Bakırköy Tıp Dergisi, 17(1), 100 - 107. 10.5222/BMJ.2021.77200 |
| Chicago | EROL Ahmet Tolga,Aşar Sinan,OREN BILGIN Beyza,Çukurova Zafer,Sabaz Mehmet Süleyman Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul. Bakırköy Tıp Dergisi 17, no.1 (2021): 100 - 107. 10.5222/BMJ.2021.77200 |
| MLA | EROL Ahmet Tolga,Aşar Sinan,OREN BILGIN Beyza,Çukurova Zafer,Sabaz Mehmet Süleyman Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul. Bakırköy Tıp Dergisi, vol.17, no.1, 2021, ss.100 - 107. 10.5222/BMJ.2021.77200 |
| AMA | EROL A,Aşar S,OREN BILGIN B,Çukurova Z,Sabaz M Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul. Bakırköy Tıp Dergisi. 2021; 17(1): 100 - 107. 10.5222/BMJ.2021.77200 |
| Vancouver | EROL A,Aşar S,OREN BILGIN B,Çukurova Z,Sabaz M Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul. Bakırköy Tıp Dergisi. 2021; 17(1): 100 - 107. 10.5222/BMJ.2021.77200 |
| IEEE | EROL A,Aşar S,OREN BILGIN B,Çukurova Z,Sabaz M "Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul." Bakırköy Tıp Dergisi, 17, ss.100 - 107, 2021. 10.5222/BMJ.2021.77200 |
| ISNAD | EROL, Ahmet Tolga vd. "Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul". Bakırköy Tıp Dergisi 17/1 (2021), 100-107. https://doi.org/10.5222/BMJ.2021.77200 |
