Abstract
Aim: It has been reported that mortality rates due to Covid-19 in elderly patients are higher than in younger patients. This study aimed to describe the clinical features of Covid-19 in patients over 65 years of age and to evaluate the factors affecting mortality. Method: 263 patients who applied to XXX XXX Hospital Emergency Department between 11.03.2020 and 31.05.2021 were included in this study. Age, gender, admission complaint, medications, comorbid diseases of patients with positive Covid-19 polymerase chain reaction (PCR) test were analyzed retrospectively through the laboratory electronic information management system. According to these data, the comparison of deceased and surviving patients was made. Results: The mortality rate was higher in those with complaints of dyspnea, cough, sputum, altered consciousness, and general condition disorder in 263 patients included in the study. It was determined that the mean fingertip saturation (SpO2) values of the deceased cases were lower than the surviving cases (p<0.001). It was determined that the mean heart rate per minute and mean respiratory rate of the deceased cases were higher than the surviving cases (p<0.001). Non steroidal anti-inflammatory drug and antiaggregant use was more common in survivors (p=0.046, p=0.027). It was determined that the use of anticoagulants was higher in deceased cases (p=0.021). It was determined that inotrope, intubation, non invasive mechanical ventilation and steroid were applied more frequently in deceased cases (p<0.001). It was determined that antiviral, antibiotic, anticoagulant treatment was applied more in survivors (p=0.026, p=0.002, p=0.009, respectively). Pneumonia, renal failure, sepsis, and electrolyte disturbances were observed to be more common in patients who died (p<0.001, p<0.001, p<0.001, p<0.001, respectively). It was observed that death could occur in cases with SpO2 ≤86%, pulse rate >99/min, and respiratory rate >26/min. While SpO2 and respiratory rate had a high discriminatory power for mortality (p<0.001, AUC=0.779; p<0.001, AUC=0.723, respectively), pulse rate had a moderate discriminatory power for mortality (p<0.001, AUC=0.659). Conclusion: It is important to define especially vital signs, blood gas findings, treatments applied in the emergency room and additional diagnoses in Covid-19, which has a higher mortality rate in elderly patients. Our study can be a guide in this respect.
References
- HN, et al. Neutrophil to lymphocyte ratio and C-reactive protein level as prognostic markers in mild versus severe COVİD-19 patients. Gastroenterol Hepatol Bed Bench. 2020;13(4):36.
- Capdevila-Reniu A, Pellice M, Prieto-González S, et al. Clinical characteristics and outcome of patients aged over 80 years with Covid-19. Medicine (Baltimore). 2021;100(8):e24750.
- Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVİD-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323:1239–1242.
- Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323:1061–1069.
- Esme M, Koca M, Dikmeer A, et al. Older Adults With Coronavirus Disease 2019: A Nationwide Study in Turkey. J Gerontol A Biol Sci Med Sci. 2021;76(3):e68-e75.
- Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVİD-19 in the New York City Area. JAMA, 2020;e20677.
- Borobia AM, Carcas AJ, Arnalich F, et al. A cohort of patients with COVİD-19 in a major teaching hospital in Europe. J Clin Med. 2020;9:E1733.
- Frater JL, Zini G, d’Onofrio G, Rogers HJ. COVİD-19 and the clinical hematology laboratory. Int J Lab Hematol. 2020;42(suppl 1):11–18.
- Capdevila-Reniu A, Pellice M, Prieto-González S, et al. Hospital Clínic COVİD-19 Research Group. Clinical characteristics and outcome of patients aged over 80 years with Covid-19. Medicine (Baltimore). 2021 Feb 26;100(8):e24750
- Zerah L, Baudouin É, Pépin M, et al. Clinical Characteristics and Outcomes of 821 Older Patients With SARS-Cov-2 Infection Admitted to Acute Care Geriatric Wards. J Gerontol A Biol Sci Med Sci. 2021 Feb 25;76(3):e4-e12.
- Moore N, Bosco-Levy P, Thurin N, Blin P, Droz-Perroteau C. NSAIDs and COVİD-19: A Systematic Review and Meta-analysis. Drug Saf. 2021 Sep;44(9):929-938
- Zenk J, Liu F, Wang Y, et al. The effect of previous oral anticoagulant use on clinical outcomes in COVİD-19: A systematic review and meta-analysis. American Journal of Emergency Medicine.2022; 54:107-110.
- Borobia AM, Carcas AJ, Arnalich F, et al. A cohort of patients with COVİD-19 in a major teaching hospital in Europe. J Clin Med. 2020;9:E1733.Published 2020 Jun 4.
- Bezuidenhout MC, Wiese OJ, Moodley D, et al. Correlating arterial blood gas, acid-base and blood pressure abnormalities with outcomes in COVİD-19 intensive care patients [published correction appears in Ann Clin Biochem. 2022 Mar;59(2):152].
- Zhang B, Zhou X, Qiu Y, et al. Clinical characteristics of 82 death cases with COVİD-19. PLoS One. 2020;15(7):e0235458.
- Liao D, Zhou F, Luo L, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVİD-19: a retrospective cohort study. Lancet Haematol. 2020;S2352-3026(20)30217-9.
- Ji M, Yuan L, Shen W, et al. Characteristics of disease progress in patients with coronavirus disease 2019 in Wuhan, China. Epidemiol Infect. 2020;148: e94
- Li Q, Ding X, Xia G, et al. Eosinopenia and elevated C-reactive protein facilitate triage of COVİD-19 patients in fever clinic: a retrospective case-control study. Clin Med. 2020;23:100375.
- Feng X, Li S, Sun Q, et al. Immune-Inflammatory Parameters in COVİD-19 Cases: A Systematic Review and Meta-Analysis. Front Med. 2020;7:301.
- 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 19 (COVİD-19). Clin Chem Lab Med. 2020;58(7):1021–1028.
- Liao D, Zhou F, Luo L, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVİD-19: a retrospective cohort study. Lancet Haematol [published online ahead of print July 10, 2020]. Lancet Haematol. 2020.
- WHO. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected https://apps.who.int/iris/bitstream/handle/10665/330893/WHO-nCoV-Clinical-2020.3-eng.pdf Erişim tarihi: 01.07.2022.
Abstract
Amaç: Yaşlı hastalarda Covid-19’a bağlı ölüm oranlarının genç hastalara göre daha yüksek olduğu bildirilmiştir. Bu çalışma 65 yaş üstü hastalarda Covid-19’un klinik özelliklerini tanımlamayı ve mortaliteye etki eden faktörlerin değerlendirilmesini amaçlamaktadır. Yöntem: Bu çalışmaya XXX XXX Hastanesi Acil Servisi’ne 11.03.2020 ile 31.05.2021 tarihleri arasında başvuran 263 hasta dahil edildi. Covid-19 polimeraz zincir reaksiyon (PZR) testi pozitif olan hastaların yaş, cinsiyet, başvuru şikayeti, kullandığı ilaçlar, komorbid hastalıkları, laboratuvar elektronik bilgi yönetim sistemi üzerinden retrospektif olarak incelendi. Bu verilere göre ölen ve sağ kalan hastaların karşılaştırması yapıldı. Bulgular: Çalışmaya dahil edilen 263 hastada nefes darlığı, öksürük, balgam, bilinç değişikliği, genel durum bozukluğu şikayeti olanlarda ölüm oranının daha fazla olduğu görüldü. Ölen olguların ortalama parmak ucu satürasyon (SpO2)değerlerinin yaşayan olgulara göre daha düşük olduğu tespit edildi (p<0.001). Ölen olguların dakikada ortalama nabız sayılarının ve ortalama solunum sayılarının yaşayan olgulara göre daha yüksek olduğu tespit edildi (p<0.001). Sağ kalanlarda non steroid anti-inflamatuar ilaç ve antiagregan kullanımı daha fazla görüldü (p=0.046, p=0.027). Ölen olgularda antikoagülan kullanımının daha fazla olduğu tespit edildi (p=0.021). İnotrop, entübasyon, non invazif mekanik entilasyon ve steroidin ölen olgularda daha çok uygulandığı tespit edildi (p<0.001). Antiviral, antibiyotik, antikoagülan, tedavinin sağ kalan olgularda daha çok uygulandığı tespit edildi (p=0.026, p=0.002, p=0.009). Ölen olgularda pnömoni, böbrek yetmezliği, sepsis ve elektrolit bozukluğunun daha fazla olduğu gözlendi (p<0.001, p<0.001, p<0.001, p<0.001). SpO2 için ≤%86, nabız için >99/dk ve solunum sayısı >26/dk olan olgularda ölüm olabileceği gözlendi. SpO2 ve solunum sayısının mortaliteyi ayırıcı gücü yüksek iken (sırasıyla p<0.001, AUC=0.779; p<0.001, AUC=0.723) nabız için orta derecedeydi (p<0.001, AUC=0.659). Sonuç: Yaşlı hastalarda daha yüksek mortalite oranına sahip olan COVİD-19’da özellikle vital bulgular, kan gazı bulguları, acil serviste uygulanan tedaviler ve ek tanıları tanımlamak önemlidir. Çalışmamız bu açıdan yol gösterici olabilir.
Keywords
References
- HN, et al. Neutrophil to lymphocyte ratio and C-reactive protein level as prognostic markers in mild versus severe COVİD-19 patients. Gastroenterol Hepatol Bed Bench. 2020;13(4):36.
- Capdevila-Reniu A, Pellice M, Prieto-González S, et al. Clinical characteristics and outcome of patients aged over 80 years with Covid-19. Medicine (Baltimore). 2021;100(8):e24750.
- Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVİD-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323:1239–1242.
- Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323:1061–1069.
- Esme M, Koca M, Dikmeer A, et al. Older Adults With Coronavirus Disease 2019: A Nationwide Study in Turkey. J Gerontol A Biol Sci Med Sci. 2021;76(3):e68-e75.
- Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVİD-19 in the New York City Area. JAMA, 2020;e20677.
- Borobia AM, Carcas AJ, Arnalich F, et al. A cohort of patients with COVİD-19 in a major teaching hospital in Europe. J Clin Med. 2020;9:E1733.
- Frater JL, Zini G, d’Onofrio G, Rogers HJ. COVİD-19 and the clinical hematology laboratory. Int J Lab Hematol. 2020;42(suppl 1):11–18.
- Capdevila-Reniu A, Pellice M, Prieto-González S, et al. Hospital Clínic COVİD-19 Research Group. Clinical characteristics and outcome of patients aged over 80 years with Covid-19. Medicine (Baltimore). 2021 Feb 26;100(8):e24750
- Zerah L, Baudouin É, Pépin M, et al. Clinical Characteristics and Outcomes of 821 Older Patients With SARS-Cov-2 Infection Admitted to Acute Care Geriatric Wards. J Gerontol A Biol Sci Med Sci. 2021 Feb 25;76(3):e4-e12.
- Moore N, Bosco-Levy P, Thurin N, Blin P, Droz-Perroteau C. NSAIDs and COVİD-19: A Systematic Review and Meta-analysis. Drug Saf. 2021 Sep;44(9):929-938
- Zenk J, Liu F, Wang Y, et al. The effect of previous oral anticoagulant use on clinical outcomes in COVİD-19: A systematic review and meta-analysis. American Journal of Emergency Medicine.2022; 54:107-110.
- Borobia AM, Carcas AJ, Arnalich F, et al. A cohort of patients with COVİD-19 in a major teaching hospital in Europe. J Clin Med. 2020;9:E1733.Published 2020 Jun 4.
- Bezuidenhout MC, Wiese OJ, Moodley D, et al. Correlating arterial blood gas, acid-base and blood pressure abnormalities with outcomes in COVİD-19 intensive care patients [published correction appears in Ann Clin Biochem. 2022 Mar;59(2):152].
- Zhang B, Zhou X, Qiu Y, et al. Clinical characteristics of 82 death cases with COVİD-19. PLoS One. 2020;15(7):e0235458.
- Liao D, Zhou F, Luo L, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVİD-19: a retrospective cohort study. Lancet Haematol. 2020;S2352-3026(20)30217-9.
- Ji M, Yuan L, Shen W, et al. Characteristics of disease progress in patients with coronavirus disease 2019 in Wuhan, China. Epidemiol Infect. 2020;148: e94
- Li Q, Ding X, Xia G, et al. Eosinopenia and elevated C-reactive protein facilitate triage of COVİD-19 patients in fever clinic: a retrospective case-control study. Clin Med. 2020;23:100375.
- Feng X, Li S, Sun Q, et al. Immune-Inflammatory Parameters in COVİD-19 Cases: A Systematic Review and Meta-Analysis. Front Med. 2020;7:301.
- 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 19 (COVİD-19). Clin Chem Lab Med. 2020;58(7):1021–1028.
- Liao D, Zhou F, Luo L, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVİD-19: a retrospective cohort study. Lancet Haematol [published online ahead of print July 10, 2020]. Lancet Haematol. 2020.
- WHO. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected https://apps.who.int/iris/bitstream/handle/10665/330893/WHO-nCoV-Clinical-2020.3-eng.pdf Erişim tarihi: 01.07.2022.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Early Pub Date | August 1, 2023 |
| Publication Date | August 17, 2023 |
| Submission Date | April 10, 2023 |
| Acceptance Date | May 17, 2023 |
| Published in Issue | Year 2023 Volume: 16 Issue: 2 |
Cite
MEU Journal of Health Sciences Assoc was began to the publishing process in 2008 under the supervision of Assoc. Prof. Gönül Aslan, Editor-in-Chief, and affiliated to Mersin University Institute of Health Sciences. In March 2015, Prof. Dr. Caferi Tayyar Şaşmaz undertook the Editor-in Chief position and since then he has been in charge.
Publishing in three issues per year (April - August - December), it is a multisectoral refereed scientific journal. In addition to research articles, scientific articles such as reviews, case reports and letters to the editor are published in the journal. Our journal, which has been published via e-mail since its inception, has been published both online and in print. Following the Participation Agreement signed with TÜBİTAK-ULAKBİM Dergi Park in April 2015, it has started to accept and evaluate online publications.
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