Öz

Amaç

Mortaliteyi etkileyen faktörlerin belirlenmesi, koronavirüs hastalığı-2019’da (COVID-19) sağkalımın iyileştirilmesi açısından çok önemlidir. Bu çalışmanın amacı, COVID-19 hastalarının demografik, klinik ve laboratuvar özelliklerini ve yoğun bakım ünitesi (YBÜ) mortalitesini etkileyen faktörleri belirlemektir.

Gereç ve Yöntem

Bu çalışma YBÜ’deki COVID-19 tanılı hastaların dahil edildiği retrospektif bir kohort çalışması olarak tasarlandı. Klinik ve laboratuvar parametreleri mortalite ve sağkalım kohortları arasında karşılaştırıldı. Parametrelerin mortalite üzerindeki etki profilleri için tek değişkenli ve çok değişkenli lojistik regresyon analizleri yapıldı.

Bulgular

Mortalite %58,6 olup üç pandemi dalgası veya seçilen zaman aralıkları için benzerdi (p=0,245). Komorbid hastalık varlığı, yaş, COVID-19 ile ilişkili komplikasyonlar, başvurudaki akut fizyoloji ve kronik sağlık değerlendirmesi II (APACHE II) ve sıralı organ yetmezliği değerlendirmesi (SOFA) skorları mortalite kohortunda anlamlı olarak daha yüksekti (p<0,001). Çok değişkenli lojistik regresyon modeline göre mortaliteyi etkileyen faktörler hipertansiyon, malignite (solid ve hematolojik), nörolojik hastalık, yaş, APACHE-II ve SOFA skorları ve nötrofil/lenfosit oranıdır.

Sonuç

Bu risk faktörlerine sahip hastalar, YBÜ bakımının zamanlaması ve süresi açısından daha dikkatli izlenmelidir.

Anahtar Kelimeler: COVID-19, mortalite, yoğun bakım ünitesi

Referanslar

  1. World Health Organization. Coronavirus disease (COVID-19) Novel Coronavirus (2019-nCoV) Situation reports. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports (2020).
  2. World Health Organization. WHO Coronavirus (COVID-19) Dashboard. https://covid19.who.int/ (2023).
  3. Magesh S, John D, Li WT, Li Y, Mattingly-App A, Jain S, et al. Disparities in COVID-19 outcomes by race, ethnicity, and socioeconomic status: a systematic-review and meta-analysis. JAMA Netw Open 2021;4:e2134147.
  4. Al-Amin M, Islam MN, Li K, Shiels N, Buresh J. Is there an association between hospital staffing levels and inpatient-COVID-19 mortality rates? PLoS One. 2022;17:e0275500.
  5. Wan TK, Huang RX, Tulu TW, Liu JD, Vodencarevic A, Wong CW, et al. Identifying predictors of COVID-19 mortality using machine learning. Life (Basel). 2022;12:547.
  6. ARDS Definition Task Force; Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307:2526-33.
  7. World Health Organization. Living guidance for clinical management of COVID-19. https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-2 (2021).
  8. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801-10.
  9. Kellum JA, Lameire N; KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013;17:204.
  10. Reid J, Daya R, Zingoni ZM, Jassat W, Bayat Z, Nel J. COVID-19 in-hospital mortality during the first two pandemic waves, at Helen Joseph Hospital, South Africa. Pan Afr Med J. 2023;45:5.
  11. Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378:1965-75.
  12. Lavrentieva A, Kaimakamis E, Voutsas V, Bitzani M. An observational study on factors associated with ICU mortality in Covid-19 patients and critical review of the literature. Sci Rep. 2023;13:7804.
  13. Umeh C, Tuscher L, Ranchithan S, Watanabe K, Gupta R. Predictors of COVID-19 mortality in critically ill ICU patients: a multicenter retrospective observational study. Cureus. 2022;14:e20952.
  14. Karacan Gölen M, Yılmaz Okuyan D, İlban Ö, Tutar MS, Işık ŞM. The relationship of laboratory parameters and mortality of patients followed in intensive care units with COVID-19. J Health Sci Med. 2022;5:1015-22.
  15. Gündoğan K, Akbudak İH, Hancı P, Halaçlı B, Temel Ş, Güllü Z, et al. Clinical outcomes and independent risk factors for 90-day mortality in critically Ill patients with respiratory failure infected with SARS-CoV-2: a multicenter study in Turkish Intensive Care Units. Balkan Med J. 2021;38:296–303.
  16. Bayrak V, Şentürk Durukan N, Demirer Aydemir F, Ergan B, Gezer NS, Eren Kutsoylu OÖ, et al. Risk factors associated with mortality in intensive care COVID-19 patients: the importance of chest CT score and intubation timing as risk factors. Turk J Med Sci. 2021;51:1665-74.
  17. Uzundere O, Kaçar CK, Erbatur ME, Gül MS, Akgündüz M, Korhan Z, et al. Factors affecting the mortality of patients in critical condition with coronavirus disease-2019 in the intensive care unit. Turk J Intensive Care. 2021;19:54-61.
  18. Sungurtekin H, Ozgen C, Arslan U, Saracoglu KT, Yarar V, Sari A, et al. Characteristics and outcomes of 974 COVID-19 patients in intensive care units in Turkey. Ann Saudi Med. 2021;41:318-26.
  19. Girgin S, Aksun M, Tüzen AS, Şencan A, Şanlı O, Kırbaş G, et al. Effects of comorbidities associated with COVID-19 cases in Intensive Care Unit on mortality and disease progression. Eur Rev Med Pharmacol Sci. 2023;27:3753-65.
  20. Begum H, Neto AS, Alliegro P, Broadley T, Trapani T, Campbell LT, et al. People in intensive care with COVID-19: demographic and clinical features during the first, second, and third pandemic waves in Australia. Med J Aust. 2022;217:352-60.
  21. Sargin Altunok E, Satici C, Dinc V, Kamat S, Alkan M, Demirkol MA, et al. Comparison of demographic and clinical characteristics of hospitalized COVID-19 patients with severe/critical illness in the first wave versus the second wave. J Med Virol. 2021;94:291-7.
  22. Taylor EH, Marson EJ, Elhadi M, Macleod KDM, Yu YC, Davids R, et al. Factors associated with mortality in patients with COVID-19 admitted to intensive care: a systematic review and meta-analysis. Anaesthesia. 2021;76:1224-32.
  23. Alharthy A, Aletreby W, Faqihi F, Balhamar A, Alaklobi F, Alanezi K, et al. Clinical characteristics and predictors of 28-day mortality in 352 critically Ill patients with COVID-19: a retrospective study. J Epidemiol Glob Health. 2021;11:98-104.
  24. Abolfotouh MA, Musattat A, Alanazi M, Alghnam S, Bosaeed M. Clinical characteristics and outcome of Covid-19 illness and predictors of in-hospital mortality in Saudi Arabia. BMC Infect Dis. 2022;22:950.
  25. Parohan M, Yaghoubi S, Seraji A, Javanbakht MH, Sarraf P, Djalali M. Risk factors for mortality in patients with Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of observational studies. Aging Male. 2020;23:1416-24.
  26. Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180:1345-55.
  27. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-62.
  28. Gao YD, Ding M, Dong X, Zhang JJ, Kursat Azkur A, Azkur D, et al. Risk factors for severe and critically ill COVID-19 patients: a review. Allergy. 2021;76:428-55.
  29. Liu L, Ni SY, Yan W, Lu QD, Zhao YM, Xu YY, et al. Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action. EClinicalMedicine. 2021;40:101111.
  30. Poly TN, Islam MM, Yang HC, Lin MC, Jian WS, Hsu MH, et al. Obesity and mortality among patients diagnosed with COVID-19: a systematic review and meta-analysis. Front Med (Lausanne). 2021;8:620044.
  31. Machado-Alba JE, Valladales-Restrepo LF, Machado-Duque ME, Gaviria-Mendoza A, Sánchez-Ramírez N, Usma-Valencia AF, et al. Factors associated with admission to the intensive care unit and mortality in patients with COVID-19, Colombia. PLoS One. 2021;16:e0260169.
  32. Zanella A, Florio G, Antonelli M, Bellani G, Berselli A, Bove T, et al. Time course of risk factors associated with mortality of 1260 critically ill patients with COVID-19 admitted to 24 Italian intensive care units. Intensive Care Med. 2021;47:995-1008.
  33. Korang SK, von Rohden E, Veroniki AA, Ong G, Ngalamika O, Siddiqui F, et al. Vaccines to prevent COVID-19: A living systematic review with Trial Sequential Analysis and network meta-analysis of randomized clinical trials. PLoS One. 2022;17:e0260733.
  34. Mohammed I, Nauman A, Paul P, Ganesan S, Chen KH, Jalil SMS, et al. The efficacy and effectiveness of the COVID-19 vaccines in reducing infection, severity, hospitalization, and mortality: a systematic review. Hum Vaccin Immunother. 2022;18:2027160.
  35. Suah JL, Husin M, Tok PSK, Tng BH, Thevananthan T, Low EV, et al. Waning COVID-19 vaccine effectiveness for BNT162b2 and CoronaVac in Malaysia: an observational study. Int J Infect Dis. 2022;119:69-76.
  36. Toker İ, Kılınç Toker A, Turunç Özdemir A, Çelik İ, Bol O, Bülbül E. Vaccination status among patients with the need for emergency hospitalizations related to COVID-19. Am J Emerg Med. 2022;54:102-6.
  37. Raschke RA, Agarwal S, Rangan P, Heise CW, Curry SC. Discriminant accuracy of the SOFA score for determining the probable mortality of patients with COVID-19 pneumonia requiring mechanical ventilation. JAMA. 2021;325:1469-70.
  38. Cheng P, Wu H, Yang J, Song X, Xu M, Li B, et al. Pneumonia scoring systems for severe COVID-19: which one is better. Virol J. 2021;18:33.
  39. Beigmohammadi MT, Amoozadeh L, Rezaei Motlagh F, Rahimi M, Maghsoudloo M, Jafarnejad B, et al. Mortality predictive value of APACHE II and SOFA scores in COVID-19 patients in the intensive care unit. Can Respir J. 2022;2022:5129314.
  40. Simadibrata DM, Calvin J, Wijaya AD, Ibrahim NAA. Neutrophil-to-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients: a meta-analysis. Am J Emerg Med. 2021;42:60-9.
  41. Ganesan R, Mahajan V, Singla K, Konar S, Samra T, Sundaram SK, et al. Mortality prediction of COVID-19 patients at intensive care unit admission. Cureus. 2021;13:e19690.
  42. Parthasarathi A, Padukudru S, Arunachal S, Basavaraj CK, Krishna MT, Ganguly K, et al. The role of neutrophil-to-lymphocyte ratio in risk stratification and prognostication of COVID-19: a systematic review and meta-analysis. Vaccines (Basel). 2022;10:1233.
  43. Ayed M, Borahmah AA, Yazdani A, Sultan A, Mossad A, Rawdhan H. Assessment of clinical characteristics and mortality-associated factors in COVID-19 critical cases in Kuwait. Med Princ Pract. 2021;30:185-92.
  44. Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, et al. An official american thoracic society/european society of intensive care medicine/society of critical care medicine clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195:1253-63.
  45. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159-68.
  46. Lee HJ, Kim J, Choi M, Choi WI, Joh J, Park J, et al. Efficacy and safety of prone position in COVID-19 patients with respiratory failure: a systematic review and meta-analysis. Eur J Med Res. 2022;27:310.
  47. Aweimer A, Petschulat L, Jettkant B, Köditz R, Finkeldei J, Dietrich JW, et al. Mortality rates of severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation in the Middle Ruhr Region of Germany. Sci Rep. 2023;13:6442.
  48. Aljishi RS, Alkuaibi AH, Al Zayer FA, Al Matouq AH. Extracorporeal membrane oxygenation for COVID-19: a systematic review. Cureus. 2022;14:e27522.
  49. RECOVERY Collaborative Group; Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021;384:693-704.
  50. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180:934-43.
  51. Wang Y, Jiang W, He Q, Wang C, Liu B, Zhou P, et al. Early, low-dose and short-term application of corticosteroid treatment in patients with severe COVID-19 pneumonia: single-center experience from Wuhan, China. 2020.
  52. Greos LS, Vichyanond P, Bloedow DC, Irvin CG, Larsen GL, Szefler SJ, et al. Methylprednisolone achieves greater concentrations in the lung than prednisolone. A pharmacokinetic analysis. Am Rev Respir Dis. 1991;144: 586-92.
  53. Chen RC, Tang XP, Tan SY, Liang BL, Wan ZY, Fang JQ, et al. Treatment of severe acute respiratory syndrome with glucosteroids: the Guangzhou experience. Chest. 2006;129:1441-52.
  54. Hui DS, Sung JJ. Severe acute respiratory syndrome. Chest. 2003;124:12-15.
  55. Meduri GU, Golden E, Freire AX, Taylor E, Zaman M, Carson SJ, et al. Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest. 2007;131:954-63.
  56. Hashimoto S, Sanui M, Egi M, Ohshimo S, Shiotsuka J, Seo R, et al. The clinical practice guideline for the management of ARDS in Japan. J Intensive Care. 2017;5:50.
  57. Arabi YM, Mandourah Y, Al-Hameed F, Sindi AA, Almekhlafi GA, Hussein MA, et al. Corticosteroid therapy for critically Ill patients with middle east respiratory syndrome. Am J Respir Crit Care Med. 2018;197: 757-67.
  58. Kaçmaz B, Keske Ş, Sişman U, Ateş ST, Güldan M, Beşli Y, et al. COVID-19 associated bacterial infections in intensive care unit: a case control study. Sci Rep. 2023;13:13345.
  59. Garcia-Vidal C, Sanjuan G, Moreno-García E, Puerta-Alcalde P, Garcia-Pouton N, Chumbita M, et al. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect. 2021;27:83-88.

Telif hakkı ve lisans

Telif hakkı © 2025 Yazar(lar). Açık erişimli bu makale, orijinal çalışmaya uygun şekilde atıfta bulunulması koşuluyla, herhangi bir ortamda veya formatta sınırsız kullanım, dağıtım ve çoğaltmaya izin veren Creative Commons Attribution License (CC BY) altında dağıtılmıştır.

Nasıl atıf yapılır?

1.
Özer B, Arslan Yıldız Ü, Kavaklı AS, Cengiz M, Temel H, Yılmaz M. COVID-19’da Mortaliteyi Etkileyen Faktörler. Turk J Intensive Care. 2025;23(1):38-52. https://doi.org/10.4274/tybd.galenos.2024.50469