{"id":23826,"date":"2021-12-27T12:15:26","date_gmt":"2021-12-27T09:15:26","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=23826"},"modified":"2021-12-27T13:13:22","modified_gmt":"2021-12-27T10:13:22","slug":"covid-19-pandemisi-deneyimi","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2021\/12\/27\/covid-19-pandemisi-deneyimi\/","title":{"rendered":"COVID-19 Pandemisinin \u0130lk Dalgas\u0131nda Bir E\u011fitim ve Ara\u015ft\u0131rma Hastanesi Deneyimi: Yo\u011fun Bak\u0131m \u0130htiyac\u0131 ile \u0130li\u015fkili Risk Fakt\u00f6rleri"},"content":{"rendered":"

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

COVID-19, ilk olarak Aral\u0131k 2019\u2019da \u00c7in\u2019in Vuhan \u015fehrinde ortaya \u00e7\u0131km\u0131\u015f ve Mart 2020\u2019de D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) taraf\u0131ndan pandemi kabul edilmi\u015ftir. G\u00fcn\u00fcm\u00fczde 176 milyona yak\u0131n do\u011frulanm\u0131\u015f olgu ve 3.5 milyonu a\u015fk\u0131n \u00f6l\u00fcm ile d\u00fcnya \u00e7ap\u0131nda pandemi devam etmektedir (1). <\/span><\/p>\n

COVID-19; ate\u015f, halsizlik, \u00f6ks\u00fcr\u00fck gibi semptomlarla hafif seyredebilece\u011fi gibi solunum deste\u011fi ihtiyac\u0131na da sebep olan a\u011f\u0131r akut alt solunum yolu infeksiyonu yapabilmektedir (2). Halen onaylanm\u0131\u015f etkene \u00f6zg\u00fc tedavisi yoktur. Hastalar\u0131n y\u00f6netiminde oksijen deste\u011fi ve yo\u011fun bak\u0131m takibi \u00f6nem arz etmektedir. \u00d6zellikle \u00e7oklu komorbiditesi olan hastalarda yo\u011fun bak\u0131m yat\u0131\u015f oranlar\u0131 %20\u2019leri bulmaktad\u0131r (3).<\/p>\n

Yo\u011fun bak\u0131m ve mekanik ventilasyon ihtiyac\u0131na veya \u00f6l\u00fcme neden olan fakt\u00f6rlerin de\u011ferlendirildi\u011fi bir\u00e7ok \u00e7al\u0131\u015fma ve meta analizde; ileri ya\u015f, komorbid hastal\u0131klar\u0131n varl\u0131\u011f\u0131, lenfopeni, CRP y\u00fcksekli\u011fi gibi fakt\u00f6rler k\u00f6t\u00fc prognoz ile ili\u015fkili bulunmu\u015ftur (4, 5, 6).<\/p>\n

Hastal\u0131\u011f\u0131n y\u00f6netiminde, yo\u011fun bak\u0131m ihtiyac\u0131 gerekebilecek \u00f6ncelikli hastalar\u0131n belirlenmesi i\u00e7in etki eden risk fakt\u00f6rlerinin bilinmesi \u00f6nemlidir. \u00c7al\u0131\u015fmam\u0131zda, pandeminin ilk dalgas\u0131nda COVID-19 tan\u0131s\u0131 ile hastanemize yat\u0131r\u0131larak takip edilen hastalar\u0131n demografik \u00f6zelliklerini ve yo\u011fun bak\u0131m ihtiyac\u0131na etki eden fakt\u00f6rleri irdeledik.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

Sa\u011fl\u0131k Bilimleri \u00dcniversitesi \u00dcmraniye E\u011fitim ve Ara\u015ft\u0131rma Hastanesi\u2019nde, 01 Nisan 2020-30 Haziran 2020 tarihleri aras\u0131nda COVID-19 tan\u0131s\u0131 ile takip edilen hastalar\u0131n dosyalar\u0131 retrospektif olarak irdelendi. Sa\u011fl\u0131k Bilimleri \u00dcniversitesi \u00dcmraniye E\u011fitim ve Ara\u015ft\u0131rma Hastanesi Etik Komitesi\u2019nden 25 Haziran 2020 tarihinde 250 karar numaras\u0131yla onay al\u0131nd\u0131.<\/p>\n

Hastanemizde yatan ve COVID-19 tan\u0131s\u0131 konan 18 ya\u015f\u0131ndan b\u00fcy\u00fck hastalar\u0131n demografik verileri, klinik bulgular\u0131 ve laboratuvar de\u011ferleri hastane t\u0131bbi kay\u0131tlar\u0131ndan elde edildi. Ba\u015fvuru an\u0131nda d\u0131\u015f merkeze sevk edilmesi gereken, d\u0131\u015f yo\u011fun bak\u0131m \u00fcnitesinden hastanemize nakledilen, yat\u0131\u015f\u0131n\u0131n ilk 48 saati i\u00e7inde \u00f6len hastalar ve 18 ya\u015f alt\u0131 bireyler \u00e7al\u0131\u015fma d\u0131\u015f\u0131 b\u0131rak\u0131ld\u0131.<\/p>\n

Toplanan demografik veriler; ya\u015f, cinsiyet, kan grubu, komorbiditeler [hipertansiyon, diabetes mellitus (DM), kronik obstr\u00fcktif akci\u011fer hastal\u0131\u011f\u0131 (KOAH), koroner arter hastal\u0131\u011f\u0131 (KAH), malignite, kronik b\u00f6brek yetmezli\u011fi (KBY) ve konjestif kalp yetmezli\u011fi (KKY)] idi. Hastalar\u0131n, hastaneye yat\u0131\u015flar\u0131ndan sonraki ilk 24 saat i\u00e7inde vital bulgular\u0131, laboratuvar de\u011ferleri (l\u00f6kosit, CRP, D-dimer, ferritin, fibrinojen, kreatinin ve lenfosit) ve toraks bilgisayarl\u0131 tomografi (BT) bulgular\u0131 incelendi.<\/p>\n

Toraks BT S\u0131n\u0131flamas\u0131<\/h3>\n

Toraks BT s\u0131n\u0131flamas\u0131 \u00fc\u00e7 \u015fekilde yap\u0131ld\u0131: 1) Hafif tutulum; \u00fc\u00e7 veya daha az odakta hepsi 3 cm\u2019den k\u00fc\u00e7\u00fck buzlu cam dansitesi, 2) orta tutulum; \u00fc\u00e7ten fazla odakta veya 3 cm\u2019den b\u00fcy\u00fck buzlu cam dansitesi veya konsolidasyon ve 3) a\u011f\u0131r tutulum; her iki akci\u011ferde t\u00fcm loblarda tutulum s\u00f6z konusu olup lezyonlar\u0131n en az \u00fc\u00e7\u00fcn\u00fcn 3 cm\u2019den b\u00fcy\u00fck olmas\u0131 (7).<\/p>\n

Sonlan\u0131m noktas\u0131, yo\u011fun bak\u0131mda takip ihtiyac\u0131 olarak kabul edildi. Hastalar\u0131n yo\u011fun bak\u0131m ihtiyac\u0131 karar\u0131; dispne ve solunum distresi, solunum say\u0131s\u0131>30\/dk, PaO2\/FiO2<300, oksijen ihtiyac\u0131n\u0131n izlemde art\u0131\u015f g\u00f6stermesi, 5 L\/dk oksijen tedavisine ra\u011fmen SPO2<90 ve PaO2<70 olmas\u0131, hipotansiyon, akut organ disfonksiyonu geli\u015fimi, imm\u00fcns\u00fcpresyon, troponin y\u00fcksekli\u011fi, aritmi, laktat>2 mmol, kapiller geri d\u00f6n\u00fc\u015f bozuklu\u011fu ve kutis marmoratus gibi cilt bozukluklar\u0131n\u0131n varl\u0131\u011f\u0131 gibi bulgularla verildi (8).<\/p>\n

Veriler, \u201cIBM SPSS Statistics for Windows, Version 25.0\u201d (IBM, Armonk, NY) program\u0131 kullan\u0131larak analiz edildi. Verilerin da\u011f\u0131l\u0131m\u0131n normalli\u011fi Kolmogorov-Smirnov testi kullan\u0131larak kontrol edildi. \u00c7al\u0131\u015fma verileri de\u011ferlendirilirken tan\u0131mlay\u0131c\u0131 istatistiksel y\u00f6ntemlerin (medyan, minimum, maksimum, frekans) yan\u0131 s\u0131ra parametrik olmayan veriler i\u00e7in \u03c7\u00b2<\/span> ve Mann-Whitney U testi kullan\u0131ld\u0131. Yo\u011fun bak\u0131ma yat\u0131\u015f\u0131 etkileyen ba\u011f\u0131ms\u0131z risk fakt\u00f6rlerini de\u011ferlendirmek i\u00e7in \u00e7ok de\u011fi\u015fkenli lojistik regresyon analizi kullan\u0131ld\u0131. De\u011fi\u015fkenler %95 g\u00fcven aral\u0131\u011f\u0131 ile hesapland\u0131. B\u00fct\u00fcn de\u011ferler i\u00e7in p<\/i><0.05 anlaml\u0131 kabul edildi.<\/p>\n

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

Tablo 1.<\/strong> Yo\u011fun Bak\u0131m ve Serviste Takip Edilen COVID-19 Hastalar\u0131n\u0131n Demografik, Klinik \u00d6zellikleri ve Sonu\u00e7lar\u0131<\/p><\/div>\n

\u00c7al\u0131\u015fmaya dahil edilen 143 hastan\u0131n 89 (%62.2)\u2019u erkek ve ya\u015f ortalamas\u0131 59\u00b115 idi. Hastalar\u0131n 69 (%48.3)\u2019u 60 ya\u015f\u0131n \u00fcst\u00fcndeydi. Kan gruplar\u0131na g\u00f6re de\u011ferlendirildi\u011finde 74 (%51.7)\u2019\u00fcn\u00fcn A grubu, 21 (%14.7)\u2019inin B grubu, 40 (%28)\u2019\u0131n\u0131n 0 grubu, 8 (%5.6)\u2019inin AB grubu, 129 (%90.2)\u2019unun Rh-pozitif oldu\u011fu g\u00f6r\u00fcld\u00fc. Hastalar\u0131n %59.2\u2019sinde en az bir komorbidite vard\u0131. En s\u0131k g\u00f6r\u00fclen komorbidite, hipertansiyon (n:52, %36.4) olup ard\u0131ndan s\u0131rayla DM (n:46, %32.2), KOAH (n:27, %18.9), KAH (n:16, %11.2), malignite (n:12, %8.1), KBY (n:11, %7.7) ve KKY (n:11, %7.7) gelmekteydi. Ba\u015fvuru esnas\u0131nda 23 (%16.1) hastan\u0131n ate\u015fi vard\u0131. Hastane takiplerinin ilk 24 saatinde 43 (%30.1) hastan\u0131n oksijen sat\u00fcrasyonu \u226493 idi. Toraks BT s\u0131n\u0131flamas\u0131na g\u00f6re de\u011ferlendirildi\u011finde 75 (%52.5) hastada hafif, 37 (%25.9) hastada orta, 31 (%21.7) hastada a\u011f\u0131r tutulum oldu\u011fu g\u00f6r\u00fcld\u00fc (Tablo 1).<\/p>\n

Takiplerinde yo\u011fun bak\u0131m ihtiyac\u0131 geli\u015fen 39 (%27.2) hasta oldu. Bunlar\u0131n 28\u2019i mekanik ventilasyon, 11\u2019i non-invazif solunum deste\u011fi ile takip edildi. Malignite tan\u0131s\u0131, ate\u015fi, toraks BT tutulumu a\u011f\u0131r olan hastalarda yo\u011fun bak\u0131m ihtiyac\u0131 istatistiksel olarak anlaml\u0131 \u015fekilde y\u00fcksekti (p<\/i><0.05). Serviste takip edilen hastalarda KOAH tan\u0131s\u0131 olmas\u0131 istatistiksel olarak anlaml\u0131 bulundu (p<<\/i>0.05). Yo\u011fun bak\u0131m ihtiyac\u0131 ile cinsiyet, ya\u015f, kan grubu, Rh fakt\u00f6r\u00fc, DM, hipertansiyon, KAH, KBY ve KKY aras\u0131nda anlaml\u0131 istatistiksel sonu\u00e7 bulunamad\u0131 (Tablo 1).<\/p>\n

Yo\u011fun bak\u0131m ihtiyac\u0131 olan hastalarda mortalite oran\u0131 %84.6 (n:33) olarak saptand\u0131. \u00c7al\u0131\u015fmaya dahil edilen t\u00fcm hastalar de\u011ferlendirildi\u011finde ise mortalite oran\u0131 %23.1 (n:33) bulundu. Eksitus olan hastalar\u0131n hepsi yo\u011fun bak\u0131m takibindeydi.<\/p>\n

\"\"<\/a>

Tablo 2.<\/strong> COVID-19 Hastalar\u0131n\u0131n Laboratuvar De\u011ferleri<\/p><\/div>\n

\u00c7al\u0131\u015fmaya dahil edilen hastalar\u0131n medyan laboratuvar de\u011ferleri; l\u00f6kosit:5850 103<\/sup>\/Ul, CRP:3.4mg\/dl, D-dimer:727ng\/ml, ferritin:220ng\/ml, fibrinojen:485 mg\/dl, kreatinin:0.9 mg\/dL, lenfosit:1240 103<\/sup>\/Ul olarak bulundu. Yo\u011fun bak\u0131m ihtiyac\u0131 geli\u015fen hastalarda l\u00f6kosit, CRP, D-dimer, ferritin, fibrinojen, kreatinin y\u00fcksekli\u011fi ve lenfosit d\u00fc\u015f\u00fckl\u00fc\u011f\u00fc istatistiksel olarak anlaml\u0131 bulundu (p<\/i><0.05) (Tablo 2).<\/p>\n

\"\"<\/a>

Tablo 3.<\/strong> Yo\u011fun Bak\u0131m \u0130htiyac\u0131 ile \u0130li\u015fkili Risk Fakt\u00f6rleri<\/p><\/div>\n

\u00c7ok de\u011fi\u015fkenli analiz y\u00f6ntemlerinden lojistik regresyon analizi uygulanarak yap\u0131lan de\u011ferlendirmede yo\u011fun bak\u0131m ihtiyac\u0131n\u0131 etkileyen ba\u011f\u0131ms\u0131z risk fakt\u00f6rleri; ferritin >400ng\/ml olmas\u0131 (p<\/i>:0.003, OR:15.2, %95 GA:2.479-93.2) ve toraks BT\u2019de a\u011f\u0131r tutulum (p<\/i>:0.0, OR:44.92, %95 GA:5.681-355.3) olarak saptand\u0131. Hastalarda altta yatan KOAH bulunmas\u0131n\u0131n yo\u011fun bak\u0131m ihtiyac\u0131n\u0131 azaltan ba\u011f\u0131ms\u0131z bir fakt\u00f6r oldu\u011fu g\u00f6zlendi (p<\/i>:0.048, OR:0.087, %95 GA:0.008-0.979) (Tablo 3).<\/p>\n

\u0130RDELEME<\/h2>\n

COVID-19 salg\u0131n\u0131, \u00e7ok say\u0131da \u00f6l\u00fcme sebep olarak ekonomik, sosyal ve psikolojik etkileriyle t\u00fcm d\u00fcnyada devam etmektedir. \u00d6zellikle \u00e7oklu komorbiditesi olan hastalarda yo\u011fun bak\u0131m ihtiyac\u0131 ve mortalite oranlar\u0131 artmaktad\u0131r. Yo\u011fun bak\u0131m ihtiyac\u0131 gerekebilecek hastalar\u0131n belirlenmesi i\u00e7in etki eden fakt\u00f6rlerin bilinmesi hastal\u0131\u011f\u0131n y\u00f6netimi i\u00e7in \u00f6nemlidir.<\/p>\n

COVID-19 tan\u0131l\u0131 hastalar\u0131n sonu\u00e7lar\u0131 ile ilgili yap\u0131lan \u00e7al\u0131\u015fmalarda ileri ya\u015fta yo\u011fun bak\u0131m ihtiyac\u0131n\u0131n ve mortalitenin y\u00fcksek oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr (9, 10). Yak\u0131n zamanda S\u00fcrmeli ve arkada\u015flar\u0131n\u0131n (11) yapt\u0131\u011f\u0131 bir \u00e7al\u0131\u015fmada ileri ya\u015f\u0131n, yo\u011fun bak\u0131m ihtiyac\u0131 i\u00e7in risk fakt\u00f6r\u00fc oldu\u011fu bulunmu\u015ftur.\u00a0 <\/span>\u00c7al\u0131\u015fmam\u0131za dahil edilen hastalar\u0131n yar\u0131s\u0131ndan fazlas\u0131 <60 ya\u015f olup serviste ve yo\u011fun bak\u0131mda takip edilen hastalar\u0131n ya\u015f da\u011f\u0131l\u0131mlar\u0131nda anlaml\u0131 fark saptanmad\u0131. Ayr\u0131ca ileri ya\u015f, yo\u011fun bak\u0131m ihtiyac\u0131n\u0131 etkileyen fakt\u00f6rlerden biri olarak bulunmad\u0131. Bu durumun, \u00e7al\u0131\u015fmam\u0131z\u0131n \u00f6rneklem boyutunun s\u0131n\u0131rl\u0131 olmas\u0131na ba\u011fl\u0131 oldu\u011fu d\u00fc\u015f\u00fcn\u00fcld\u00fc.<\/p>\n

Salg\u0131n\u0131n ba\u015f\u0131nda yap\u0131lan bir meta-analizde cinsiyet ile COVID-19 pn\u00f6monisinin a\u011f\u0131r seyretmesi aras\u0131nda ili\u015fki bulunmam\u0131\u015ft\u0131r (13). Ancak ilerleyen d\u00f6nemlerde yap\u0131lan \u00e7ok say\u0131da \u00e7al\u0131\u015fmada erkeklerde mortalitenin daha y\u00fcksek oldu\u011fu g\u00f6sterilmi\u015ftir (9-12). Bizim \u00e7al\u0131\u015fmam\u0131zda ise literat\u00fcrden farkl\u0131 olarak cinsiyet ile yo\u011fun bak\u0131m ihtiyac\u0131 aras\u0131nda ili\u015fki saptanmad\u0131.<\/p>\n

S\u00f6z konusu \u00e7al\u0131\u015fmalarda; kan grubu, Rh fakt\u00f6r\u00fc ve COVID-19 ili\u015fkisi ile ilgili sonu\u00e7lar tart\u0131\u015fmal\u0131d\u0131r. G\u00f6ker ve arkada\u015flar\u0131n\u0131n (14) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, COVID-19’un istatistiksel olarak anlaml\u0131 bir \u015fekilde A kan grubuna sahip olanlarda daha s\u0131k, O kan grubuna sahip olanlarda ise daha az g\u00f6r\u00fcld\u00fc\u011f\u00fc bulunmu\u015ftur. Yak\u0131n zamanda yap\u0131lan bir derlemede, A ve B kan grubunun yan\u0131 s\u0131ra Rh-pozitifli\u011finin COVID-19 i\u00e7in risk fakt\u00f6r\u00fc olabilece\u011fi, O kan grubunun koruyucu olabilece\u011fi, A kan grubunun k\u00f6t\u00fc prognoz ile ili\u015fkili olabilece\u011fi d\u00fc\u015f\u00fcn\u00fclm\u00fc\u015ft\u00fcr.\u00a0 <\/span>Latz ve arkada\u015flar\u0131n\u0131n (15) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada ise kan grubu ile k\u00f6t\u00fc prognoz aras\u0131nda ili\u015fki bulunmam\u0131\u015ft\u0131r. Bizim \u00e7al\u0131\u015fmam\u0131zda da benzer olarak kan grubu ve Rh fakt\u00f6r\u00fc ile yo\u011fun bak\u0131m ihtiyac\u0131 aras\u0131nda anlaml\u0131 ili\u015fki bulunmad\u0131.<\/p>\n

Zhang ve arkada\u015flar\u0131n\u0131n (16) yapt\u0131\u011f\u0131 bir \u00e7al\u0131\u015fmada, malignite tan\u0131l\u0131 COVID-19 hastalar\u0131nda yo\u011fun bak\u0131m, mekanik ventilasyon ihtiyac\u0131 ve \u00f6l\u00fcm gibi ciddi olaylar\u0131n daha s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc saptanm\u0131\u015ft\u0131r. \u00c7al\u0131\u015fmam\u0131zda yo\u011fun bak\u0131ma yatan hastalarda malignite tan\u0131s\u0131 serviste yatan hastalara g\u00f6re daha fazla olmakla birlikte malignite yo\u011fun bak\u0131m ihtiyac\u0131 i\u00e7in ba\u011f\u0131ms\u0131z risk fakt\u00f6r\u00fc olarak bulunmad\u0131.<\/p>\n

Kipourou ve arkada\u015flar\u0131n\u0131n (17) yo\u011fun bak\u0131m ihtiyac\u0131 i\u00e7in risk fakt\u00f6rleri \u00fczerine yapt\u0131\u011f\u0131 prospektif kohort \u00e7al\u0131\u015fmada; erkek cinsiyet, KBY, ast\u0131m, KOAH ve imm\u00fcns\u00fcpresyon yo\u011fun bak\u0131m ihtiyac\u0131 i\u00e7in risk fakt\u00f6rleri olarak bulunmu\u015ftur. Mortalite gibi ciddi sonu\u00e7lar ile komorbid fakt\u00f6rlerin ili\u015fkisinin ara\u015ft\u0131r\u0131ld\u0131\u011f\u0131 ba\u015fka bir \u00e7al\u0131\u015fmada; hipertansiyon, DM, KOAH, KBY ve kardiyovask\u00fcler hastal\u0131klar istatistiksel olarak anlaml\u0131 saptanm\u0131\u015ft\u0131r (18). Bizim \u00e7al\u0131\u015fmam\u0131zda ise cinsiyet, KBY, hipertansiyon, DM gibi komorbiditeler risk fakt\u00f6r\u00fc olarak bulunmad\u0131. \u00c7al\u0131\u015fmam\u0131zda, yo\u011fun bak\u0131m ihtiyac\u0131n\u0131 etkileyen fakt\u00f6rlerin; KOAH tan\u0131s\u0131 (p<\/i>:0.048, OR:0.087, %95 GA:0.008-0.979); toraks BT\u2019de a\u011f\u0131r tutulum (p<\/i>:0.0, OR:44.92, %95 GA:5.681-355.3) ve ferritin >400ng\/ml (p<\/i>:0.003, OR:15.201, %95 GA:2.479-93.2) oldu\u011fu bulundu.<\/p>\n

On bir olgu serisinin incelendi\u011fi, 2002 hastay\u0131 kapsayan sistematik bir derlemede KOAH tan\u0131l\u0131 COVID-19 hastalar\u0131nda a\u011f\u0131r hastal\u0131k riskinin d\u00f6rt kat\u0131na \u00e7\u0131kt\u0131\u011f\u0131 (OR:4.38) bulunmu\u015ftur (19). \u00c7al\u0131\u015fmam\u0131zda ise KOAH varl\u0131\u011f\u0131n\u0131n yo\u011fun bak\u0131m ihtiyac\u0131n\u0131 azaltan ba\u011f\u0131ms\u0131z olumlu fakt\u00f6r oldu\u011fu saptand\u0131. YB\u00dc\u2019deki hastalar\u0131n ya\u015f ortalamas\u0131 ile k\u0131yasland\u0131\u011f\u0131nda daha gen\u00e7 olduklar\u0131 ve yo\u011fun bak\u0131ma gitmeyen KOAH tan\u0131l\u0131 hastalar\u0131n \u00e7o\u011funun ek komorbid durumlar\u0131n\u0131n olmad\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc. COVID-19 i\u00e7in k\u00f6t\u00fc prognoz kriterleri olan ileri ya\u015f ve \u00e7oklu komorbidite varl\u0131\u011f\u0131 bizim \u00e7al\u0131\u015fmam\u0131zda KOAH tan\u0131l\u0131 hastalar i\u00e7in ge\u00e7erli de\u011fildi. Bulgumuzun bu nedenle literat\u00fcrle \u00e7eli\u015fti\u011fi kanaatindeyiz.<\/p>\n

Yap\u0131lan \u00e7al\u0131\u015fmalarda mortalite ile akci\u011ferde etkilenen lob say\u0131s\u0131 ili\u015fkili bulunmu\u015ftur (20). S\u00fcmer ve arkada\u015flar\u0131n\u0131n (21) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada hastalar\u0131n %76.5\u2019inde toraks BT normal veya hafif olarak de\u011ferlendirilmi\u015f; mortalite oran\u0131 s\u0131f\u0131r olarak tespit edilmi\u015ftir. Yak\u0131n zamanda \u00fclkemizde yap\u0131lan bir \u00e7al\u0131\u015fmada hastaneye yat\u0131\u015f s\u0131ras\u0131nda etkilenen akci\u011fer lob say\u0131s\u0131n\u0131n \u00fc\u00e7\u00fcn \u00fczerinde olmas\u0131 \u00f6lenlerde istatistiksel anlaml\u0131 olarak saptanm\u0131\u015ft\u0131r (22). Bizim \u00e7al\u0131\u015fmam\u0131zda ise hastalar\u0131n toraks BT bulgular\u0131 ve klinikleri daha a\u011f\u0131r olup mortalite oran\u0131m\u0131z %23.1 olarak bulundu. Literat\u00fcr ile benzer olarak \u00e7al\u0131\u015fmam\u0131zda da toraks BT\u2019de a\u011f\u0131r tutulum yo\u011fun bak\u0131m ihtiyac\u0131 a\u00e7\u0131s\u0131ndan ba\u011f\u0131ms\u0131z risk fakt\u00f6r\u00fc olarak tespit edildi.<\/p>\n

COVID-19 pn\u00f6monisi, proinflamatuar sitokinlerin a\u015f\u0131r\u0131 \u00fcretimi ile sitokin f\u0131rt\u0131nas\u0131 ve \u00e7oklu organ yetmezli\u011fi klini\u011fi ile seyredebilir. Klini\u011fin k\u00f6t\u00fcle\u015fmesi durumunda hastalarda, ferritin, D-dimer, IL-6 ve laktat dehidrogenaz d\u00fczeyleri artmaktad\u0131r. Cheng ve arkada\u015flar\u0131n\u0131n (23) yapt\u0131\u011f\u0131 bir derlemede, ciddi akut karaci\u011fer yetmezli\u011fi, yo\u011fun bak\u0131m ve mekanik ventilasyon ihtiyac\u0131 olan hastalarda ferritin de\u011ferleri istatistiksel olarak y\u00fcksek saptanm\u0131\u015ft\u0131r. Yak\u0131n zamanda \u00fclkemizde yap\u0131lan bir \u00e7al\u0131\u015fmada, ferritinin (e\u015fik de\u011fer:50.8 \u00b5g\/L) ciddi seyirli hastal\u0131\u011f\u0131 \u00f6ng\u00f6ren ba\u011f\u0131ms\u0131z de\u011fi\u015fken oldu\u011fu g\u00f6sterilmi\u015ftir (24). Bizim \u00e7al\u0131\u015fmam\u0131zda da benzer olarak ferritin de\u011ferinin >400ng\/ml olmas\u0131 yo\u011fun bak\u0131m ihtiyac\u0131 i\u00e7in ba\u011f\u0131ms\u0131z risk fakt\u00f6r\u00fc olarak bulundu.<\/p>\n

\u00c7al\u0131\u015fmam\u0131z\u0131n s\u0131n\u0131rlay\u0131c\u0131 fakt\u00f6rleri, yo\u011fun bak\u0131ma yat\u0131\u015fa etkisi a\u00e7\u0131s\u0131ndan sadece hastalar\u0131n temel karakteristik \u00f6zelliklerinin\u200b\u200b de\u011ferlendirilmesiydi. Uygulanan tedavilerin (oksijen, antiviral ajanlar, anti-sitokin tedaviler, konvelesan plazma ve antibakteriyel ila\u00e7lar) sonu\u00e7la ili\u015fkisi de\u011ferlendirilmedi. Ayr\u0131ca \u00e7al\u0131\u015fmam\u0131z\u0131n \u00f6rneklem boyutunun s\u0131n\u0131rl\u0131 olmas\u0131 nedeniyle cinsiyetin yan\u0131 s\u0131ra DM ve hipertansiyon gibi risk fakt\u00f6r\u00fc oldu\u011fu bilinen komorbiditeler ile istatistiksel anlaml\u0131l\u0131k tespit edemedik. <\/span><\/p>\n

Sonu\u00e7 olarak, toraks BT\u2019de COVID-19 tipik a\u011f\u0131r tutulumuna ek olarak, yo\u011fun bak\u0131m ihtiyac\u0131 geli\u015febilecek hastalar\u0131 erken evrede ay\u0131rt etmek i\u00e7in ba\u015fvuru s\u0131ras\u0131ndaki ferritin de\u011ferleri\u00a0 <\/span>g\u00f6sterge olarak kullan\u0131labilir. COVID-19 ile hastaneye yat\u0131r\u0131lan hastalar\u0131n <\/b>y\u00f6netiminde bu <\/b>risk fakt\u00f6rlerini dikkate almak daha iyi sonu\u00e7lar al\u0131nmas\u0131n\u0131 sa\u011flayacakt\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e COVID-19, ilk olarak Aral\u0131k 2019\u2019da \u00c7in\u2019in Vuhan \u015fehrinde ortaya \u00e7\u0131km\u0131\u015f ve Mart 2020\u2019de D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) taraf\u0131ndan pandemi kabul edilmi\u015ftir. G\u00fcn\u00fcm\u00fczde 176 milyona yak\u0131n do\u011frulanm\u0131\u015f olgu ve 3.5 milyonu a\u015fk\u0131n \u00f6l\u00fcm ile d\u00fcnya \u00e7ap\u0131nda pandemi devam etmektedir (1). COVID-19; ate\u015f, halsizlik, \u00f6ks\u00fcr\u00fck gibi semptomlarla hafif seyredebilece\u011fi gibi solunum deste\u011fi ihtiyac\u0131na da sebep olan […]<\/p>\n","protected":false},"author":2,"featured_media":24129,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5347,3474,5348],"class_list":["post-23826","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-covid-19-pandemisi","tag-risk-faktorleri","tag-yogun-bakim-ihtiyaci"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/23826","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\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=23826"}],"version-history":[{"count":2,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/23826\/revisions"}],"predecessor-version":[{"id":24115,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/23826\/revisions\/24115"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/24129"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=23826"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=23826"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=23826"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}