Factors determining ARDS and mortality in Covid-19 pneumonia

Year 2021, Volume: 11 Issue: 3, 410 - 416, 24.05.2021

Adnan Yamanoğlu , Saylav Bora , Nalan Gökçe Çelebi Yamanoğlu , Cüneyt Arıkan Hüseyin Acar

https://doi.org/10.16899/jcm.931353

Abstract

Introduction
COVID-19 is caused by a newly discovered corona virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 patients often present with fever, myalgia or fatigue and dry cough. Although most patients' prognosis is thought to be benign, it is known that poor results can be observed in elderly patients and those with chronic underlying diseases.
Our aim in this study is to investigate the factors that progress to ARDS and cause mortality in patients with COVID-19 pneumonia, based on symptoms, laboratory findings, Computed Tomography (CT) findings, chronic diseases and continuous medications they use.
Material Method
Demographic characteristics of patients with Covid-19 pneumonia such as age, gender, complaints, vital signs, physical examination findings, smoking and other habits, chronic disease histories, laboratory and imaging examination results, treatment regimen applied in the hospital, hospitalization and intensive care durations were obtained and recorded in the hospital registration system. Clinical outcomes of all patients; Acute Respiratory Disitress (ARDS) has been recorded by classifying it as discharge or exitus. The definition of ARDS was made according to the Berlin criteria updated in 2012.
Result and Conclusion
In this study, low oxygen saturation at admission, chronic diuretic use, hypocalcemia, thrombocytopenia were found to be significant parameters that increase the risk for both ARDS and mortality in patients with Covid-19 pneumonia. In addition, high D-Dimer was found to be a significant risk factor for the development of ARDS, while advanced age was found to be a significant risk factor for mortality.

Keywords

Covid-19, ARDS, Diuretic use, Electrolyte disturbances

Covid-19 pnömonisinde ARDS ve mortaliteyi belirleyen faktörler

Abstract

Giriş
COVID-19, şiddetli akut solunum sendromu koronavirüs 2 (SARS-CoV-2) adı verilen yeni keşfedilen bir korona virüsten kaynaklanır. COVID-19 hastaları genellikle ateş, miyalji veya yorgunluk ve kuru öksürük ile başvurur. Çoğu hastanın prognoz’ unun selim seyirli olacağı düşünülse de yaşlı hastalar ve kronik altta yatan rahatsızlıkları olanlar da kötü sonuçların gözlenebildiği bilinmektedir
Bu çalışmada amacımız COVID-19 pnömonisi olan hastalarda ARDS’ ye ilerleyen ve mortaliteye sebep olan faktörleri semptomlar, laboratuvar bulguları, Bilgisayarlı Tomografi (BT) bulguları, kronik hastalıklar ve kullandıkları devamlı ilaçlardan yola çıkarak araştırmaktır.
Materyal Metod
Covid-19 pnomonisi olan hastaların yaş, cinsiyet gibi demografik özellikleri, şikayetleri, vital bulguları, fizik muayene bulguları, sigara kullanımı ve diğer alışkanlıkları, kronik hastalık öyküleri kullandığı ilaçlar, laboratuvar ve görüntüleme tetkik sonuçları, hastanede uygulanan tedavi rejimi, hastanede ve yoğun bakımda yatış süreleri hastane kayıt sisteminde elde edildi ve kayıt altına alındı. Tüm hastaların klinik sonlanımları; Akut Respiratuvar Disitres (ARDS) gelişip gelişmemesi, taburcuk veya exitus olarak sınıfladırılarak kayıt altına alınmıştır. ARDS tanımı 2012 yılında güncellenen Berlin kriterlerine göre yapılmıştır.
Bulgular ve Sonuç
Bu çalışmada Covid-19 pnomonisi olan hastalarda başvuru sırasındaki oksijen saturasyonu düşüklüğü, kronik diüretik kullanımı, hipokalsemi, trombositopeni hem ARDS hem de mortalite için riski artıran anlamlı parametyreler olarak bulunmuştur. Ayrıca D-Dimer yüksekliği ARDS gelişimi içinm anlamlı risk faktörü olarak bulunurken, ileri yaş ise mortalite için anlamlı risk faktörü olarak bulunmuştur.

Keywords

Covid-19, ARDS, Diuretik kullanımı, Elektrolit bozuklukları

References

• 1. Guan, W.J., Ni, Z.Y., Hu, Y. et al. (2020) Clinical characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 382, 1708–1720,
• 2. Huang, C., Wang, Y., Li, X. et al. (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395, 497–506
• 3. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia inWuhan, China: a descriptive study. Lancet. 2020;395(10223):507- 513.
• 4. Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis Syed Shahzad Hasan, Toby Capstick, Raees Ahmed, Chia Siang Kow, Faizan Mazhare, Hamid a Merchanta and Syed Tabish Razi Zaidi Expert Review of Respiratory Medicine, 14:11, 1149-1163, DOI: 10.1080/17476348.2020.1804365
• 5. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance. January 28, 2020. Accessed March 5, 2020
• 6. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307: 2526-33
• 7. Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061] 8. DG, Bigelow DB, Petty TL, Levine BE acute respiratory distress in adults.Ashbaugh Lancet. 1967;2(7511):319
• 9. Mizumoto K, Kagaya K, Zarebski A, Chowell G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill. 2020;25(10):2000180. doi:10.2807/1560-7917.ES.2020.25.10.2000180
• 10. Sakurai A, Sasaki T, Kato S, et al. Natural History of Asymptomatic SARS-CoV-2 Infection [published online ahead of print, 2020 Jun 12]. N Engl J Med. 2020;NEJMc2013020. doi:10.1056/NEJMc2013020
• 11. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966. Published 2020 May 22. doi:10.1136/bmj.m1966
• 12. W. Guan, Z. Ni, Yu Hu, W. Liang, C. Ou, J. He, L. Liu et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Feb 28. https://doi.org/10.1056/NEJMoa2002032
• 13. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep 2020;69:382–386. DOI: http://dx.doi.org/10.15585/mmwr.mm6913e2external icon.
• 14. Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis [published correction appears in Lancet Infect Dis. 2020 Apr 15;:] [published correction appears in Lancet Infect Dis. 2020 May 4;:]. Lancet Infect Dis. 2020;20(6):669-677. doi:10.1016/S1473-3099(20)30243-7
• 15. Chaolin Huang, Yeming Wang, Xingwang Li, Lili Ren, Jianping Zhao, Yi Hu, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506,» Lancet 2020; 395: 497–506
• 16. Soni M, Gopalakrishnan R, Vaishya R, Prabu P. D-dimer level is a useful predictor for mortality in patients with COVID-19: Analysis of 483 cases. Diabetes Metab Syndr. 2020;14(6):2245-2249. doi:10.1016/j.dsx.2020.11.007
• 17. Di Filippo L, Formenti AM, Rovere-Querini P, et al. Hypocalcemia is highly prevalent and predicts hospitalization in patients with COVID-19. Endocrine. 2020;68(3):475-478. doi:10.1007/s12020-020-02383-5
• 18. Güçlü E, Kocayiğit H, Okan HD, Erkorkmaz U, Yürümez Y, Yaylacı S, Koroglu M, Uzun C, Karabay O. Effect of COVID-19 on platelet count and its indices. Rev Assoc Med Bras (1992). 2020 Aug;66(8):1122-1127. doi: 10.1590/1806-9282.66.8.1122. PMID: 32935808
• 19. Nunes JPL. Mortality and use of angiotensin-converting enzyme inhibitors in COVID 19 disease: a systematic review. Porto Biomed J. 2020;5(6):e085. Published 2020 Nov 11. doi:10.1097/j.pbj.0000000000000085
• 20. Xue Zhang, Jiong Yu, Li-ya Pan, Hai-yin Jiang, ACEI/ARB use and risk of infection or severity or mortality of COVID-19: A systematic review and meta-analysis, Pharmacological Research,Volume 158,2020,104927, ISSN 1043-6618, https://doi.org/10.1016/j.phrs.2020.104927.
• 21. Pengo, M.1; Stefanini, G2,3; Pivato, C2,3; Soranna, D4; Zambra, G4; Zambon, A4,5; Torlasco, C1,6; Bilo, G1,6; Condorelli, G2,3; Parati, G1,6 IN-HOSPITAL DIURETIC USE IS ASSOCIATED WITH WORSE OUTCOME IN PATIENTS WITH COVID-19, Journal of Hypertension: April 2021 - Volume 39 - Issue - p e38 doi: 10.1097/01.hjh.0000744760.04955.3e
• 22. L. Di Filippo, A.M. Formenti, M. Doga, E. Pedone, P. Rovere- Querini, A. Giustina, Radiological Thoracic Vertebral Fractures are highly prevalent in COVID-19 and predict disease outcomes. J Clin Endocrinol Metab (2020).
• 23. J. Liu, P. Han, J. Wu, J. Gong, D. Tian, Prevalence and predictive value of hypocalcemia in severe COVID-19 patients. J. Infect. Public Health 13(9), 1224–1228 (2020).
• 24. J.K. Sun, W.H. Zhang, L. Zou et al. Serum calcium as a biomarker of clinical severity and prognosis in patients with coronavirus disease 2019. Aging 12(12), 11287–11295 (2020).
• 25. L. Di Filippo, A.M. Formenti, P. Rovere-Querini et al. Hypocalcemia is highly prevalent and predicts hospitalization in patients with COVID-19. Endocrine 68(3), 475–478 (2020)
• 26. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020 Apr 27.