{"id":21974,"date":"2021-04-23T13:37:28","date_gmt":"2021-04-23T10:37:28","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=21974"},"modified":"2021-06-02T21:19:49","modified_gmt":"2021-06-02T18:19:49","slug":"turkiyede-bir-universite-hastanesinde-covid-19-olgularinin-epidemiyolojik-ozellikleri","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2021\/04\/23\/turkiyede-bir-universite-hastanesinde-covid-19-olgularinin-epidemiyolojik-ozellikleri\/","title":{"rendered":"T\u00fcrkiye\u2019de Bir \u00dcniversite Hastanesinde COVID-19 Olgular\u0131n\u0131n Epidemiyolojik \u00d6zellikleri"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/h2>\n

\u00c7in\u2019in Wuhan, Hubei b\u00f6lgesinde ilk olarak 8 Aral\u0131k 2019\u2019da etiyolojisi bilinmeyen atipik pn\u00f6moni olgusu g\u00f6r\u00fcld\u00fc. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) 11 \u015eubat 2020\u2019de hastal\u0131\u011fa \u201cCoronavirus disease 2019\u201d (COVID-19) ad\u0131n\u0131 verdi (1-3). 11 Mart 2020\u2019de DS\u00d6 h\u0131zla yay\u0131lan COVID-19\u2019un bir pandemi oldu\u011funu ilan etti (4). COVID-19\u2019da ate\u015f, \u00f6ks\u00fcr\u00fck, halsizlik, diyare, ba\u015f a\u011fr\u0131s\u0131, kas a\u011fr\u0131s\u0131 gibi spesifik olmayan semptomlar g\u00f6r\u00fclmektedir. Klinik tablo asemptomatik bir infeksiyon ya da hafif bir \u00fcst solunum yolu hastal\u0131\u011f\u0131ndan solunum yetmezli\u011fine neden olacak a\u011f\u0131r bir pn\u00f6moniye, hatta \u00f6l\u00fcme kadar ilerleyen geni\u015f bir spektrum olu\u015fturmaktad\u0131r (5,6). \u0130leri ya\u015f, hipertansiyon, diabetes mellitus, koroner arter hastal\u0131\u011f\u0131 gibi e\u015flik eden hastal\u0131klar\u0131n varl\u0131\u011f\u0131 ve erkek cinsiyet k\u00f6t\u00fc prognozun belirleyicileri olarak g\u00f6sterilmi\u015ftir (5,7). D\u00fcnyada 21 \u015eubat 2021 itibariyle 110 763 898 olgu ve 2 455 331 \u00f6l\u00fcm bulunmaktad\u0131r (8).<\/p>\n

T\u00fcrkiye\u2019de ise ilk olgu DS\u00d6\u2019n\u00fcn pandemi ilan\u0131yla ayn\u0131 g\u00fcn olan 11 Mart 2020\u2019de duyurulmu\u015ftur. T\u00fcrkiye\u2019de 11 Mart 2020-21 \u015eubat 2021 tarihleri aras\u0131nda 2 638 422 do\u011frulanm\u0131\u015f COVID-19 olgusu ve 28 060 COVID-19 nedenli \u00f6l\u00fcm bildirilmi\u015ftir (9). Olgu ve \u00f6l\u00fcm say\u0131lar\u0131yla ilgili bilgiler ba\u015flang\u0131\u00e7ta Sa\u011fl\u0131k Bakan\u0131 taraf\u0131ndan medya arac\u0131l\u0131\u011f\u0131yla a\u00e7\u0131klanm\u0131\u015f daha sonra ise Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131na ait a\u011f sayfas\u0131ndan (https:\/\/covid19.saglik.gov.tr<\/a>\/<\/span>) g\u00fcnl\u00fck olarak duyurulmaya ba\u015flanm\u0131\u015ft\u0131r. Duyurular ba\u015flang\u0131\u00e7ta test say\u0131s\u0131, olgu say\u0131s\u0131, yo\u011fun bak\u0131m ve ent\u00fcbe hasta say\u0131lar\u0131yla iyile\u015fen hasta say\u0131lar\u0131n\u0131 i\u00e7ermekte iken daha sonra sa\u011fl\u0131k hizmetlerinin dolulu\u011fu, filyasyon durumuyla ilgili bilgiler de eklenmi\u015ftir.<\/p>\n

COVID-19 yeni bir etkene ba\u011fl\u0131 ve pek\u00e7ok \u00f6zelli\u011fi hen\u00fcz bilinmeyen bir hastal\u0131kt\u0131r. Bu nedenle bu hastal\u0131kla etkili m\u00fccadele i\u00e7in olabildi\u011fince bilgi \u00fcretilmeli ve payla\u015f\u0131lmal\u0131d\u0131r. Bu bilgiler hem sa\u011fl\u0131k hizmetlerinin planlamas\u0131nda kullan\u0131labilecek hem de modellemeler i\u00e7in daha do\u011fru varsay\u0131mlar olu\u015fturacakt\u0131r.<\/p>\n

Bu ara\u015ft\u0131rman\u0131n amac\u0131 do\u011frulanm\u0131\u015f COVID-19 olgular\u0131n\u0131n sosyodemografik \u00f6zellikleri, semptom t\u00fcrleri ve s\u0131kl\u0131klar\u0131, e\u015flik eden hastal\u0131klar\u0131 gibi epidemiyolojik \u00f6zelliklerini ortaya koymak, ayr\u0131ca yo\u011fun bak\u0131m gereksinimi ve \u00f6l\u00fcmle ili\u015fkili risk fakt\u00f6rlerini belirlemektir.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

Kesitsel tipteki bu ara\u015ft\u0131rmada 11 Haziran 2020 tarihine kadar T\u00fcrkiye\u2019de bir \u00fcniversite hastanesine ba\u015fvuran, U07.3 (COVID-19) \u201cInternational Classification of Diseases\u201d (ICD) tan\u0131 kodu alan ve revers transkriptaz-polimeraz zincir reaksiyonu (RT-PCR) testiyle SARS-CoV-2-pozitif tespit edilen ayaktan ve yatan t\u00fcm olgular incelenmi\u015ftir. Ara\u015ft\u0131rman\u0131n y\u00fcr\u00fct\u00fcld\u00fc\u011f\u00fc hastane 1100 yatak kapasiteli \u00fc\u00e7\u00fcnc\u00fc basamak bir hastanedir. Pandemi d\u00f6neminde 110 yatak COVID-19 hastalar\u0131 i\u00e7in ayr\u0131lm\u0131\u015f ve yo\u011fun bak\u0131m hasta kapasitesi 100\u2019d\u00fcr. Hastalar\u0131n demografik bilgileriyle kendilerinin ya da yak\u0131nlar\u0131n\u0131n telefon numaralar\u0131, Hastane Bilgi Y\u00f6netim Sistemi’nden elde edilmi\u015ftir. Olgularla tan\u0131 ald\u0131klar\u0131 g\u00fcn i\u00e7inde, telefon arac\u0131l\u0131\u011f\u0131 g\u00f6r\u00fc\u015f\u00fclm\u00fc\u015f, telefonla ileti\u015fim sa\u011flanamayacak a\u011f\u0131r olgulara ait bilgiler yak\u0131nlar\u0131ndan al\u0131nm\u0131\u015ft\u0131r. Olgularla ilgili bilgiler Halk Sa\u011fl\u0131\u011f\u0131 Ara\u015ft\u0131rma G\u00f6revlileri taraf\u0131ndan Olgu Bilgi Formlar\u0131 arac\u0131l\u0131\u011f\u0131yla toplanm\u0131\u015ft\u0131r. Ara\u015ft\u0131rman\u0131n yap\u0131lmas\u0131 i\u00e7in gerekli izinler ve Giri\u015fimsel Olmayan Ara\u015ft\u0131rmalar Etik Kurulu\u2019dan etik kurul onay\u0131 al\u0131nm\u0131\u015ft\u0131r (protokol numaras\u0131 5648 GOA).<\/p>\n

\u0130statiksel Analiz:<\/i><\/b><\/span> Ya\u015f, cinsiyet, meslek, sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 olma durumu, semptom \u00f6zellikleri, yurtd\u0131\u015f\u0131 seyahat etme durumu, e\u015flik eden hastal\u0131klar, sigara kullanma durumu, yat\u0131\u015f durumu (ayaktan, yatan), YB\u00dc yat\u0131\u015f\u0131 ve \u00f6l\u00fcm durumu ara\u015ft\u0131rman\u0131n de\u011fi\u015fkenlerini olu\u015fturmaktad\u0131r. B\u00f6lgede yer alan bir huzurevinde ya\u015fayan hastalar olgular i\u00e7inde \u00f6nemli bir orana sahip oldu\u011fu i\u00e7in huzurevi sakini olma durumu da ayr\u0131 bir de\u011fi\u015fken olarak ele al\u0131nm\u0131\u015ft\u0131r. Olgu Bilgi Formlar\u0131nda yer alan bilgiler IBM SPSS Statistics for Windows. Version 24.0 (Statistical Package for the Social Sciences, IBM. Corp., Armonk, NY, ABD) arac\u0131l\u0131\u011f\u0131yla analiz edilmi\u015f, tan\u0131mlay\u0131c\u0131 veriler say\u0131, ortalama, standart sapma, ortanca, minimum-maksimum de\u011ferler ve y\u00fczdelerle sunulmu\u015ftur. Ortalamalar\u0131n kar\u015f\u0131la\u015ft\u0131rmas\u0131nda t-testi, kategorik de\u011fi\u015fkenlerin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131nda Pearson \u03c72 testleri kullan\u0131lm\u0131\u015ft\u0131r. Lojistik regresyon analizi hem tek de\u011fi\u015fkenli hem de \u00e7ok de\u011fi\u015fkenli olarak uygulanm\u0131\u015f, YB\u00dc yat\u0131\u015f\u0131 ve \u00f6l\u00fcm durumu i\u00e7in risk fakt\u00f6rleri belirlenmi\u015ftir. \u00c7ok de\u011fi\u015fkenli lojistik regresyon analizi \u201cForward LR\u201d metoduyla yap\u0131lm\u0131\u015f, son ad\u0131mda anlaml\u0131 \u00e7\u0131kan sonu\u00e7lar tablolarda sunulmu\u015ftur. \u0130statistiksel anlaml\u0131l\u0131k d\u00fczeyi <0.05 olarak al\u0131nm\u0131\u015ft\u0131r.<\/span><\/p>\n

BULGULAR<\/b><\/h2>\n
\"\"<\/a>

\u015eekil 1.<\/strong>COVID-19 olgular\u0131na ait salg\u0131n e\u011frisi.<\/p><\/div>\n

\"\"<\/a>

Tablo 1.<\/strong>Olgular\u0131n Tan\u0131mlay\u0131c\u0131 \u00d6zellikleri<\/p><\/div>\n

\"\"<\/a>

Tablo 2.<\/strong>Olgularda G\u00f6r\u00fclen Ba\u015fvuru S\u0131ras\u0131nda \u0130lk ve T\u00fcm Semptomlar\u0131n Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

\"\"<\/a>

Tablo 3.<\/strong>Olgulardaki Risk Etmenlerinin S\u0131kl\u0131klar\u0131<\/p><\/div>\n

Ara\u015ft\u0131rman\u0131n yap\u0131ld\u0131\u011f\u0131 hastanede ilk olgu 19 Mart 2020\u2019de g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Bu tarihten 11 Haziran 2020\u2019ye kadar 654 ki\u015fi COVID-19 tan\u0131s\u0131 alm\u0131\u015ft\u0131r. \u015eekil 1\u2019de salg\u0131n e\u011frisi g\u00f6r\u00fclmektedir. Mart ve Nisan aylar\u0131nda ya\u015fanan art\u0131\u015f\u0131n May\u0131s\u2019\u0131n ilk iki haftas\u0131ndan sonra azald\u0131\u011f\u0131 izlenmi\u015ftir.<\/p>\n

Olgular\u0131n %51.7\u2019sini kad\u0131nlar olu\u015fturmu\u015ftur. Ya\u015f ortalamas\u0131 49.5 (\u00b122.9); ortanca 45\u2019tir. Olgular\u0131n ya\u015flar\u0131 0 (16 g\u00fcn) ile 101 aras\u0131nda de\u011fi\u015fmektedir. En fazla 40-49 (%18.8) ya\u015f grubunda olgu bulunmaktad\u0131r. Olgular\u0131n %17.9\u2019u sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131d\u0131r. Huzurevi sakinleri olgular\u0131n %18\u2019ini; huzurevi \u00e7al\u0131\u015fanlar\u0131 %9.9\u2019unu olu\u015fturmaktad\u0131r (Tablo 1).<\/p>\n

Tablo 2\u2019de olgularda ba\u015fvuruda g\u00f6r\u00fclen ilk semptomlar\u0131n ve genel olarak semptomlar\u0131n s\u0131kl\u0131klar\u0131 g\u00f6r\u00fclmektedir. \u00d6ks\u00fcr\u00fck ba\u015fvuruda en s\u0131k g\u00f6r\u00fclen ilk semptom olmu\u015ftur. Bunu ate\u015f, \u00fc\u015f\u00fcme-titreme ve halsizlik izlemektedir (s\u0131ras\u0131yla %20.7, %19.3 %15.1). Ba\u015fvurudaki t\u00fcm semptomlar incelendi\u011finde ise en s\u0131k \u00f6ks\u00fcr\u00fck, ikinci s\u0131kl\u0131kla halsizlik ve \u00fc\u00e7\u00fcnc\u00fc olarak ate\u015f, \u00fc\u015f\u00fcme-titreme g\u00f6r\u00fclm\u00fc\u015ft\u00fcr (s\u0131ras\u0131yla %39.3, %36.7, %33.9). Olgular\u0131n %19.8\u2019i ise ba\u015fvuruda asemptomatiktir (Tablo 2).<\/p>\n

Olgular\u0131n %39.9\u2019unun en az bir komorbiditesi bulunmaktad\u0131r. \u0130ki ve daha fazla komorbiditesi olanlar\u0131n s\u0131kl\u0131\u011f\u0131 ise %19.9\u2019dur. En s\u0131k olarak s\u0131ras\u0131yla hipertansiyon, diabetes mellitus ve kardiyovask\u00fcler hastal\u0131klar e\u015flik etmektedir (%25.3, %12.4, %10.7) (Tablo 3).<\/p>\n

Olgular\u0131n %43.7\u2019si hastaneye yat\u0131r\u0131larak tedavi edilmi\u015ftir. %7.6\u2019s\u0131 ise yo\u011fun bak\u0131m ko\u015fullar\u0131nda tedavi edilen kritik hastalardan olu\u015fmu\u015ftur. 654 olgunun 51\u2019i ya\u015fam\u0131n\u0131 yitirmi\u015f, olgu \u00f6l\u00fcm oran\u0131 %7.8 olarak bulunmu\u015ftur. Olgular\u0131n %1.7\u2019sinin yurtd\u0131\u015f\u0131 seyahat \u00f6yk\u00fcs\u00fc bulunmaktad\u0131r ve %68.8\u2019inin bilinen bir COVID-19 olgusuyla temas\u0131 bulunmaktad\u0131r.<\/p>\n

YB\u00dc yat\u0131\u015f\u0131 ve \u00f6l\u00fcm g\u00f6r\u00fclen ve g\u00f6r\u00fclmeyen olgular\u0131n kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131 Tablo 4\u2019te g\u00f6r\u00fclmektedir. Buna g\u00f6re yo\u011fun bak\u0131m ihtiyac\u0131 olan olgular\u0131n ya\u015f ortalamas\u0131 77.3 (\u00b115.4); olmayanlar\u0131n ya\u015f ortalamas\u0131 47.1 (\u00b121.9)\u2019dir. \u00d6len olgular\u0131n ya\u015f ortalamas\u0131 82.0 (\u00b19.2); hayatta kalan olgular\u0131n ya\u015f ortalamas\u0131 46.7 (\u00b121.6)\u2019dir (p<\/i><0.05). YB\u00dc yat\u0131\u015f\u0131 olanlar i\u00e7inde sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 olmayanlar, huzurevi sakini olanlar, ba\u015fvuruda semptomu olanlar, komorbiditesi olanlar ve komorbidite say\u0131s\u0131 fazla olanlar istatistiksel olarak anlaml\u0131 d\u00fczeyde fazlad\u0131r (p<\/i><0.05). \u00d6lenler i\u00e7inde ise sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 olmayanlar, huzurevi sakini olanlar, komorbiditesi olanlar, komorbidite say\u0131s\u0131 fazla olanlar ve YB\u00dc yat\u0131\u015f\u0131 olanlar istatistiksel olarak anlaml\u0131 d\u00fczeyde fazlad\u0131r (p<\/i><0.05) (Tablo 4).<\/p>\n

\"\"

Tablo 4.<\/strong> Yo\u011fun Bak\u0131m \u0130htiyac\u0131 ve \u00d6l\u00fcme G\u00f6re Baz\u0131 \u00d6zelliklerin Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131.<\/p><\/div>\n

\"<strong>Tablo<\/a>

Tablo 5.<\/strong>COVID-19 Olgular\u0131n\u0131n Yo\u011fun Bak\u0131m \u0130htiyac\u0131yla \u0130li\u015fkili Fakt\u00f6rlerin Belirlenmesine Y\u00f6nelik Lojistik Regresyon Analizi<\/p><\/div>\n

\"\"<\/a>

Tablo 6.<\/strong>COVID-19 Olgular\u0131n\u0131n \u00d6l\u00fcm Durumuyla \u0130li\u015fkili Fakt\u00f6rlerin Belirlenmesine Y\u00f6nelik Lojistik Regresyon Analizi<\/p><\/div>\n

Olgular\u0131n YB\u00dc yat\u0131\u015f\u0131 gerektirmesine ait risk fakt\u00f6rlerinin belirlenmesine y\u00f6nelik yap\u0131lan tek de\u011fi\u015fkenli lojistik regresyon analizine g\u00f6re; YB\u00dc yat\u0131\u015f\u0131yla ya\u015f (OR: 1.07; GA: 1.05-1.09), sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 olma (OR: 0.17; GA: 0.04-0.74), huzurevi sakini olma (OR: 6.61; GA: 3.63-12.0), ba\u015flang\u0131\u00e7ta semptom varl\u0131\u011f\u0131 (OR: 4.14; GA: 1.27-13.5), hipertansiyon (OR: 3.30; GA: 1.83-5.92), diabetes mellitus (OR: 3.10; GA: 1.59-6.05), kardiyovask\u00fcler hastal\u0131k (OR: 5.95; GA: 3.12-11.32), kronik akci\u011fer hastal\u0131\u011f\u0131 (OR: 2,.75; GA: 1.20-6.26), n\u00f6rolojik hastal\u0131k (OR: 4.45; GA: 2.04-9.70), kanser (OR: 4.58; GA: 1.94-10.83) durumlar\u0131n\u0131n g\u00f6r\u00fclmesi ve komorbidite say\u0131s\u0131 (1 komorbid varl\u0131\u011f\u0131 OR: 6.22; GA: 2.57-15.04; 2 ve \u00fczeri komorbid varl\u0131\u011f\u0131 OR: 12.61; GA: 5.56-28.59) ili\u015fkili bulunmu\u015ftur (p<\/i><0.05).<\/span><\/p>\n

\u00c7ok de\u011fi\u015fkenli analizlerde ise YB\u00dc yat\u0131\u015f\u0131n\u0131 belirleyen risk fakt\u00f6rleri, ya\u015f, erkek cinsiyet, ba\u015fvuruda semptom varl\u0131\u011f\u0131 ve kanser olarak bulunmu\u015ftur. Artan her 1 ya\u015f YB\u00dc yat\u0131\u015f\u0131n\u0131 %8 oran\u0131nda (OR: 1.08; GA: 1.06-1.10) art\u0131rmaktad\u0131r. Erkeklerin YB\u00dc yat\u0131\u015f\u0131 riski kad\u0131nlara g\u00f6re 2.71 kat daha fazlad\u0131r (OR: 2.71; GA: 1.37-5.39); ba\u015fvuruda semptomu olan ki\u015filer olmayanlara g\u00f6re 6.32 (OR: 6.32; GA: 1.81-22.01); kanser olanlar olmayanlara g\u00f6re 3.72 (OR: 3.72; GA: 1.35-10.20) kat daha fazla YB\u00dc yat\u0131\u015f\u0131 g\u00f6stermi\u015ftir (p<\/i><0.05) (Tablo 5).<\/p>\n

COVID-19 olgular\u0131n\u0131n \u00f6l\u00fcm durumuna ait risk fakt\u00f6rlerinin belirlenmesine y\u00f6nelik yap\u0131lan tek de\u011fi\u015fkenli lojistik regresyon analizine g\u00f6re; ya\u015f (OR: 1.09; GA: 1.07-1.15), sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 olma (OR: 0.84; GA: 0.11-0.61), huzurevi sakini olma (OR: 11.1; GA: 6.02-20.73), hipertansiyon (OR: 3.16; GA: 1.77-5.65), diabetes mellitus (OR: 3.77; GA: 1.97-7.18), kardiyovask\u00fcler hastal\u0131k (OR: 5.17; GA: 2.70-9.87), kronik akci\u011fer hastal\u0131\u011f\u0131 (OR: 3.17; GA: 1.43-7.0), n\u00f6rolojik hastal\u0131k (OR: 5.85; GA: 2.78-12.32), kanser (OR: 5.38; GA: 2.34-12.37) durumlar\u0131n\u0131n g\u00f6r\u00fclmesi, komorbidite say\u0131s\u0131 (1 komorbid varl\u0131\u011f\u0131 OR: 6.59; GA: 2.60-16.73; 2 ve \u00fczeri komorbid varl\u0131\u011f\u0131 OR: 16.5; GA: 7.05-38.76) ve YB\u00dc yat\u0131\u015f\u0131 (OR: 174.9; GA: 72.55-421.67) \u00f6l\u00fcmle ili\u015fkili bulunmu\u015ftur (p<\/i><0.05).<\/span><\/p>\n

\u00c7ok de\u011fi\u015fkenli analizlerde ise \u00f6l\u00fcm durumunu belirleyen risk fakt\u00f6rleri, ya\u015f, kanser ve YB\u00dc yat\u0131\u015f\u0131 olarak bulunmu\u015ftur. Artan her 1 ya\u015f \u00f6l\u00fcm riskini %10 oran\u0131nda (OR: 1.10; GA: 1.06-1.15) art\u0131rmaktad\u0131r. Kanser olanlarda olmayanlara g\u00f6re 5.22 kat (OR: 5.22; GA: 1.09-24.89); YB\u00dc yat\u0131\u015f\u0131 olanlarda \u00f6l\u00fcm riski olmayanlara g\u00f6re 87.42 kat artmaktad\u0131r (OR: 87.42; GA: 30.15-153.46) (p<\/i><0.05) (Tablo 6).<\/p>\n

\u0130RDELEME<\/b><\/h2>\n

Bu ara\u015ft\u0131rma, 19 Mart 2020 ve 11 Haziran 2020 aras\u0131nda 654 COVID-19 olgusunun \u00f6zelliklerini inceleyerek T\u00fcrkiye\u2019de COVID-19 pandemisinin erken d\u00f6nemdeki \u00f6zellikleriyle ilgili bilgi sunmaktad\u0131r. \u0130lk olgu 19 Mart 2020\u2019de tan\u0131 ald\u0131ktan sonra olgu say\u0131s\u0131 h\u0131zla y\u00fckselmi\u015f Nisan ay\u0131nda en y\u00fcksek de\u011ferlere ula\u015fm\u0131\u015ft\u0131r. Nisan ay\u0131nda g\u00f6r\u00fclen iki pik seviyenin ilkinin nedeni huzurevinde yap\u0131lan tarama, ikincisinin nedeni ise sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na yap\u0131lan taramad\u0131r. Olgu say\u0131s\u0131n\u0131n May\u0131s\u2019\u0131n ilk iki haftas\u0131ndan sonra azald\u0131\u011f\u0131 g\u00f6r\u00fclmektedir.<\/p>\n

Ara\u015ft\u0131rmada olgu \u00f6l\u00fcm oran\u0131 %7.8 olarak bulunmu\u015ftur. Daha \u00f6nce yap\u0131lan ve hem ayaktan hem yatan hastalar\u0131 i\u00e7eren ara\u015ft\u0131rmalarda olgu \u00f6l\u00fcm oran\u0131 %0.5-%3.1 aras\u0131nda de\u011fi\u015fmektedir (2,7,10-12). Olgu \u00f6l\u00fcm oran\u0131n\u0131n bu \u015fekilde y\u00fcksek \u00e7\u0131kmas\u0131n\u0131n nedeni b\u00f6lgedeki huzurevinden pek \u00e7ok ileri ya\u015fl\u0131 hastan\u0131n bulunmas\u0131d\u0131r. \u00d6len 51 hastan\u0131n 33\u2019\u00fc huzurevinde kalmaktad\u0131r.<\/p>\n

T\u00fcm olgular\u0131n %7.6\u2019s\u0131 yo\u011fun bak\u0131m \u00fcnitesinde tedavi edilmi\u015ftir. Bu s\u0131kl\u0131k daha \u00f6nceki bir ara\u015ft\u0131rmada %5 bulunmu\u015ftur (12). Benzer \u015fekilde bu durum da huzurevinden olan ba\u015fvurulara ba\u011flanabilir \u00e7\u00fcnk\u00fc t\u00fcm olgular\u0131n %18\u2019ini huzurevi sakinleri olu\u015fturmaktad\u0131r ve YB\u00dc yat\u0131\u015f\u0131 olan 50 hastan\u0131n 27\u2019si huzurevinde kalmaktad\u0131r. Yine bu durumla ili\u015fkili olarak YB\u00dc yat\u0131\u015f\u0131 olan hastalar\u0131n %78\u2019i \u00f6lm\u00fc\u015ft\u00fcr. Literat\u00fcrde yer alan iki sistematik derleme yo\u011fun bak\u0131m \u00fcnitesi mortalitesini %41.6 ve %51.8 olarak bulmu\u015ftur (13,14). Bu ara\u015ft\u0131rman\u0131n huzurevinde kalan \u00f6zel bir grubu i\u00e7ermesi bu farkl\u0131l\u0131\u011f\u0131n sebebi olarak g\u00f6r\u00fclmektedir. Bir di\u011fer neden literat\u00fcrdeki ara\u015ft\u0131rmalar\u0131n yo\u011fun bak\u0131m \u00f6l\u00fcml\u00fcl\u00fc\u011f\u00fcne 30 g\u00fcnden az s\u00fcrede takip edilen hastalar\u0131 alm\u0131\u015f olmas\u0131 olabilir. Bu ara\u015ft\u0131rmada b\u00f6yle bir zaman s\u0131n\u0131rlamas\u0131 yap\u0131lmam\u0131\u015ft\u0131r.<\/p>\n

Olgularda ba\u015fvuruda en s\u0131k \u00f6ks\u00fcr\u00fck, halsizlik ve ate\u015f semptomlar\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Daha \u00f6nce yay\u0131mlanan bir derlemede de bu semptomlar ilk 3 s\u0131rada yer alm\u0131\u015ft\u0131r (15).<\/p>\n

Semptomlar aras\u0131nda dikkat \u00e7ekici olan koku ve\/veya tat alamama semptomlar\u0131n\u0131n s\u0131kl\u0131\u011f\u0131n\u0131n y\u00fcksekli\u011fidir. COVID-19 ile ilgili ilk yay\u0131nlarda bu semptomlardan bahsedilmemi\u015ftir. Pandeminin ilerleyen aylar\u0131nda patogenezi netle\u015fmemi\u015f olsa da anosmia\/tat alamama semptomlar\u0131 COVID-19\u2019a ait non-spesifik semptomlardan kabul edilmi\u015f, klinisyenler i\u00e7in bu semptomlar\u0131n uyar\u0131c\u0131 olmas\u0131 gerekti\u011fi belirtilmi\u015ftir (16). Hatta 2021 y\u0131l\u0131nda yay\u0131mlanan bir ara\u015ft\u0131rmaya g\u00f6re ani koku kayb\u0131 COVID-19 olgular\u0131n\u0131n %46.7\u2019sinde g\u00f6r\u00fclmektedir ve olgular\u0131n %19.2\u2019sinde tek belirti koku kayb\u0131d\u0131r (17).<\/p>\n

Ba\u015fvuruda asemptomatik olgular ise t\u00fcm olgular\u0131n 5\u2019te 1\u2019ini olu\u015fturmaktad\u0131r. Ba\u015fka bir ara\u015ft\u0131rmada ise bu ara\u015ft\u0131rmayla benzer bir sonu\u00e7 elde edilmi\u015ftir (%19.2) (18). Diamond Princess gemisi yolcular\u0131nda retrospektif olarak d\u00fczenlenen bir ara\u015ft\u0131rmada ise olgular\u0131n %41\u2019inin ba\u015flang\u0131\u00e7ta asemptomatik oldu\u011fu belirlenmi\u015ftir (19). Ancak bu oranlar ba\u015fvurudaki asemptomatik olgular\u0131 g\u00f6stermektedir. Asemptomatik olgular\u0131 inceleyen bir sistematik derleme tan\u0131 an\u0131nda asemptomatik olgular\u0131n %48.9\u2019unda daha sonra semptom geli\u015fti\u011fini belirtmektedir (20). Bu ara\u015ft\u0131rmada ba\u015fvuruda asemptomatik olgular\u0131n daha sonra semptom geli\u015fimi bak\u0131m\u0131ndan takip edilmemesi bir s\u0131n\u0131rl\u0131l\u0131k olarak kabul edilebilir.<\/p>\n

Bu ara\u015ft\u0131rmada COVID-19 YB\u00dc yat\u0131\u015f\u0131 ve \u00f6l\u00fcm durumuyla ili\u015fkili risk fakt\u00f6rlerinin daha do\u011fru olarak belirlenmesi i\u00e7in \u00e7ok de\u011fi\u015fkenli lojistik regresyon analizi kullan\u0131lm\u0131\u015ft\u0131r. Buna g\u00f6re ilerleyen ya\u015f hem YB\u00dc yat\u0131\u015f\u0131n\u0131 hem de \u00f6l\u00fcmleri art\u0131rmaktad\u0131r. Farkl\u0131 \u00fclkelerde yap\u0131lan ara\u015ft\u0131rmalarda da COVID-19\u2019a ba\u011fl\u0131 mortalitenin ilerleyen ya\u015fla beraber artt\u0131\u011f\u0131 tespit edilmi\u015ftir (5,7,21).<\/p>\n

Bu ara\u015ft\u0131rmada \u00e7ok de\u011fi\u015fkenli analizlerde erkek cinsiyetin COVID-19 nedenli YB\u00dc yat\u0131\u015f\u0131n\u0131 yakla\u015f\u0131k 3 kat artt\u0131rd\u0131\u011f\u0131 tespit edilmi\u015ftir. Daha \u00f6nce yap\u0131lan baz\u0131 ara\u015ft\u0131rmalarda da benzer sonu\u00e7lar elde edilmi\u015ftir. Bu durum erkeklerde ACE2 resept\u00f6r ekspresyonunun fazla olmas\u0131 ve \u00f6strojen ve X kromozomunun koruyuculu\u011fundan yoksun olmaya ba\u011flanm\u0131\u015ft\u0131r (7.11). Kanser ise hem YB\u00dc yat\u0131\u015f\u0131n\u0131 hem de \u00f6l\u00fcm riskini art\u0131rmaktad\u0131r. COVID-19 hastal\u0131\u011f\u0131n\u0131n kanser hastalar\u0131nda daha a\u011f\u0131r tablolara yol a\u00e7t\u0131\u011f\u0131 ve mortaliteyi art\u0131rd\u0131\u011f\u0131 daha \u00f6nce yap\u0131lan baz\u0131 ara\u015ft\u0131rmalarda da g\u00f6sterilmi\u015ftir (22-24).<\/p>\n

Bu ara\u015ft\u0131rman\u0131n g\u00fc\u00e7l\u00fc yan\u0131 19 Mart 2020-11 Haziran 2020 tarihleri aras\u0131nda tan\u0131 alan t\u00fcm COVID-19 olgular\u0131na ait verileri i\u00e7ermesi ve \u00e7ok de\u011fi\u015fkenli analizlerle daha do\u011fru bulgular\u0131n ortaya konulmu\u015f olmas\u0131d\u0131r.<\/p>\n

Sonu\u00e7 olarak T\u00fcrkiye\u2019de COVID-19 pandemisinin erken d\u00f6neminde tan\u0131 alan 654 olgunun epidemiyolojik \u00f6zelliklerinin sunuldu\u011fu bu ara\u015ft\u0131rma, hastal\u0131kla ilgili temel bilgiler sunmaktad\u0131r. Ya\u015fla beraber hastal\u0131\u011f\u0131n seyrinin a\u011f\u0131rla\u015ft\u0131\u011f\u0131 ve \u00f6l\u00fcmlerin artt\u0131\u011f\u0131 belirlenmi\u015ftir. Erkek cinsiyet YB\u00dc yat\u0131\u015f\u0131 riskini, kanser ise hem YB\u00dc yat\u0131\u015f\u0131 hem de \u00f6l\u00fcm riskini art\u0131rmaktad\u0131r. Ya\u015fl\u0131, erkek ve komorbiditesi olan gruplar dikkate al\u0131nmal\u0131d\u0131r. COVID-19 hastal\u0131\u011f\u0131yla ilgili h\u00e2l\u00e2 pek \u00e7ok bilinmeyen bulunmaktad\u0131r. Daha geni\u015f \u00f6rneklemlerle yap\u0131lacak daha ayr\u0131nt\u0131l\u0131 ara\u015ft\u0131rmalar pandemi m\u00fccadelesinde kritik \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e \u00c7in\u2019in Wuhan, Hubei b\u00f6lgesinde ilk olarak 8 Aral\u0131k 2019\u2019da etiyolojisi bilinmeyen atipik pn\u00f6moni olgusu g\u00f6r\u00fcld\u00fc. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) 11 \u015eubat 2020\u2019de hastal\u0131\u011fa \u201cCoronavirus disease 2019\u201d (COVID-19) ad\u0131n\u0131 verdi (1-3). 11 Mart 2020\u2019de DS\u00d6 h\u0131zla yay\u0131lan COVID-19\u2019un bir pandemi oldu\u011funu ilan etti (4). COVID-19\u2019da ate\u015f, \u00f6ks\u00fcr\u00fck, halsizlik, diyare, ba\u015f a\u011fr\u0131s\u0131, kas a\u011fr\u0131s\u0131 gibi spesifik […]<\/p>\n","protected":false},"author":3,"featured_media":22672,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5174,2660,5188,5189,4015],"class_list":["post-21974","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-covid-19","tag-epidemiyoloji","tag-koronavirus","tag-sars-cov-2","tag-turkiye"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/21974","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=21974"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/21974\/revisions"}],"predecessor-version":[{"id":22918,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/21974\/revisions\/22918"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/22672"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=21974"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=21974"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=21974"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}