COVID-19 Polikliniğine Ayaktan Başvuran Hastaların Semptomları ve Kötü Sonlanım İlişkisinin Değerlendirilmesi: Retrospektif Kohort Çalışma

Yıl 2021, Cilt: 4 Sayı: 1, 1 - 5, 31.03.2021

Serdar Özdemir , Hatice Akça , İbrahim Altunok , Abdullah Algın , Abuzer Özkan , Emin Pala , Serkan Emre Eroğlu

Öz

Amaç: COVID-19 polikliniğine başvuran hastaların semptomları ile kısa süreli mortalite, servis yatışı, yoğun bakıma yatışı ve hastanede kalış süresince mekanik ventilasyon gerekliliği arasındaki ilişkiyi değerlendirmek.

Gereç ve Yöntemler: Çalışmamız retrospektif kohort çalışma olarak bir pandemi kliniğinde gerçekleştirildi. SARS-CoV-2 için pozitif RT-PCR testi olan tüm hastanede yatan hastalar ve ayakta tedavi gören erişkin hastalar çalışmaya dahil edildi. Hastanenin bilgisayar tabanlı hasta veri sisteminden her hastanın demografik parametreleri, klinik özellikleri, başvuru sırasındaki vital parametreler, poliklinik sonuçları elde edildi ve analiz edildi. Bu çalışmanın birincil sonlanımı, COVID-19 polikliniğine başvuran hastaların semptomları ile 30 günlük mortalite arasındaki ilişkiyi belirlemekti. İkincil sonlanımları ise, hastanede yatış, yoğun bakıma yatış ve hastanede kalış sırasında mekanik ventilasyon gerekliliğiydi.

Bulgular: SARS-CoV-2 için RT-PCR testinin pozitif sonuçlarına sahip toplam 1566 hasta dahil edildi. 30 günlük mortalite ve hastaneye yatış oranları sırasıyla% 3.6 ve% 35.1 idi. En sık görülen semptomlar öksürük (% 56,7) ve ateş (% 33,3) idi. Kısa süreli mortalite, YBÜ'ye yatış ve hastanede kalış sırasında mekanik ventilasyon gerekliliği ile öksürük ve nefes darlığı ilişkili bulundu (öksürük için P = 0,029, P = 0,003, P = 0,03; nefes darlığı için P <0,001, p <0,001 ve P = 0,009 sırasıyla).

Sonuç: Öksürük ve nefes darlığı 30 günlük mortalite, YBÜ'ye yatış ve hastanede kalış sırasında mekanik ventilasyon gerekliliği ile ilişkilidir.

Anahtar Kelimeler

Koronavirüs enfeksiyonları, Nefes darlığı, Türkiye, Ateş, Öksürük, Prognoz

Evaluation of the Relationship between Symptoms and Poor Prognosis on Patients Admitted to COVID-19 Outpatient Clinic: Retrospective Cohort Study

Öz

Aim: To evaluate the relationships between the symptoms of patients admitted to the COVID-19 outpatient clinic and short-term mortality, hospitalization, intensive care unit admission and necessity of mechanical ventilation during hospitalization.

Material and Methods: This retrospective cohort study was conducted at a pandemic clinic. All hospitalized patients and outpatients with positive RT-PCR assay for SARS-CoV-2 were included the study. Demographic parameters, clinical characteristics, vital parameters on admission, outpatient clinic outcomes of each patient were obtained from the hospital computer-based patient data system and analyzed. Primary outcome of this study was determining the relationship between the symptoms of patients admitted to the COVID-19 outpatient clinic and 30-day mortality. The secondary outcomes were hospitalization, intensive care unit admission, and necessity of mechanical ventilation during hospitalization.

Results: A total of 1566 patients with positive results of RT-PCR assay for SARS-CoV-2 were included. The rates of 30-day mortality and hospitalization were 3.6% and 35.1%, respectively. The most common symptoms were cough (56.7%) and fever (33.3%). Cough and shortness of breath associated with short-term mortality, ICU admission and necessity of mechanical ventilation during hospitalization (for cough P = 0.029, P = 0.003, P = 0.03; for shortness of breath P <0.001, p <0.001, and P = 0.009, respectively).

Conclusion: The cough and shortness of breath were associated with 30-day mortality, ICU admission and necessity of mechanical ventilation during hospitalization.

Anahtar Kelimeler

Coronavirus infections, Dyspnea, Turkey, Fever, Cough, Prognosis

Kaynakça

• Aksel G, İslam MM, Algın A, et al. Early predictors of mortality for moderate to severely ill patients with Covid-19. Am J Emerg Med. 2020 Aug 28:S0735-6757(20)30770-1. doi: 10.1016/j.ajem.2020.08.076.
• Sahin D, Tanacan A, Erol SA, et al. Updated experience of a tertiary pandemic center on 533 pregnant women with COVID-19 infection: A prospective cohort study from Turkey. Int J Gynaecol Obstet. 2020 Nov 1. doi: 10.1002/ijgo.13460.
• Koca F. Promotion of scientific research on COVID-19 in Turkey. Lancet. 2020 Sep 12;396(10253):e25-e26. doi: 10.1016/S0140-6736(20)31864-X.
• Khan G, Sheek-Hussein M, Al Suwaidi AR et al. Novel coronavirus pandemic: A global health threat. Turk J Emerg Med. 2020 May 27;20(2):55-62. doi: 10.4103/2452-2473.285016.
• COVID-19 Algoritmalar [Internet] [cited. Apr 15, 2020]. Available from: https://covid19bilgi.saglik.gov.tr/tr/algoritmalar
• Zheng J. SARS-CoV-2: An Emerging Coronavirus that Causes a Global Threat. Int J Biol Sci. 2020;16(10):1678-1685. Published 2020 Mar 15. doi:10.7150/ijbs.45053.
• Shoji H, Fonseca EKUN, Teles GBDS, et al. Structured thoracic computed tomography report for COVID-19 pandemic. Einstein (São Paulo). 2020; 18:eED5720.
• Houshyar R, Tran-Harding K, Glavis-Bloom J, et al. Effect of shelter-in-place on emergency department radiology volumes during the COVID-19 pandemic. Emerg Radiol. 2020; 5;1-4.
• Struyf T, Deeks JJ, Dinnes J, et al. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease. Cochrane Database Syst Rev. 2020 Jul 7;7(7):CD013665. doi: 10.1002/14651858.CD013665.
• Pan L, Mu M, Yang P, et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020;115(5):766-773. doi:10.14309/ajg.0000000000000620.
• Carfì A, Bernabei R, Landi F, for the Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603–605. doi:10.1001/jama.2020.12603.
• Altinbilek E, Ozturk D, Ozkurt H, et al. Comparison of laboratory results and chest CT findings in COVID-19 patients. Annals of Clinical and Analytical Medicine ; 11(6):587-591, 2020.
• Lian J, Jin X, Hao S, et al. Analysis of Epidemiological and Clinical Features in Older Patients with Coronavirus Disease 2019 (COVID-19) Outside Wuhan. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2020 Jul;71(15):740-747. DOI: 10.1093/cid/ciaa242.
• Zhao D, Yao F, Wang L, et al. A Comparative Study on the Clinical Features of Coronavirus 2019 (COVID-19) Pneumonia with Other Pneumonias. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2020 Jul;71(15):756-761. DOI: 10.1093/cid/ciaa247.
• Huang D, Lian X, Song F, et al. Clinical features of severe patients infected with 2019 novel coronavirus: a systematic review and meta-analysis. Ann Transl Med. 2020;8(9):576. doi:10.21037/atm-20-2124.
• Baksh M, Ravat V, Zaidi A, Patel RS. A Systematic Review of Cases of Acute Respiratory Distress Syndrome in the Coronavirus Disease 2019 Pandemic. Cureus. 2020;12(5):e8188. doi:10.7759/cureus.8188.
• Wang Y, Wang Y, Chen Y, et al. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol. 2020;92(6):568-576. doi:10.1002/jmv.25748.