{"id":24753,"date":"2022-05-23T12:32:57","date_gmt":"2022-05-23T09:32:57","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=24753"},"modified":"2022-06-27T13:26:44","modified_gmt":"2022-06-27T10:26:44","slug":"covid-19-infeksiyonu-ve-prognoz","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2022\/05\/23\/covid-19-infeksiyonu-ve-prognoz\/","title":{"rendered":"COVID-19 \u0130nfeksiyonunda May\u0131s-A\u011fustos 2020 D\u00f6neminde Yo\u011fun Bak\u0131ma Yat\u0131\u015f ve Mortalite ile \u0130li\u015fkili Fakt\u00f6rler"},"content":{"rendered":"

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

Ciddi akut solunum sendromu koronavirus-2 (SARS-CoV-2) etkeni ile geli\u015fen koronavirus hastal\u0131\u011f\u0131 2019 (COVID-19) infeksiyonunun neden oldu\u011fu pandemi t\u00fcm d\u00fcnyadaki etkisini s\u00fcrd\u00fcrmektedir (1). COVID-19 infeksiyonun seyri, hastalarda klinik asemptomatik seyirden kritik hastal\u0131\u011fa ba\u011fl\u0131 \u00f6l\u00fcme kadar de\u011fi\u015fen \u00e7e\u015fitlilik g\u00f6stermektedir (1). A\u011f\u0131r COVID-19 infeksiyonu olan hastalarda; nefes darl\u0131\u011f\u0131, y\u00fcksek solunum say\u0131s\u0131, d\u00fc\u015f\u00fck oksijen sat\u00fcrasyonu ve yayg\u0131n akci\u011fer tutulumuna ait bulgular mevcuttur (2, 3). Yo\u011fun bak\u0131m takibi gerektiren kritik hastalarda ise; mekanik ventilasyon gerektiren solunum yetmezli\u011fi, \u015fok, yayg\u0131n koag\u00fclopatinin yan\u0131 s\u0131ra \u00e7oklu organ yetmezli\u011fi de g\u00f6r\u00fclebilir (3). COVID-19 infeksiyonu olan olgular\u0131n %14\u2019\u00fc a\u011f\u0131r klinik seyir g\u00f6sterirken, yo\u011fun bak\u0131mda izlem gerektiren kritik hastalar t\u00fcm olgular\u0131n %5\u2019ini olu\u015fturmaktad\u0131r (1). Hastal\u0131\u011fa ait olgu \u00f6l\u00fcm oran\u0131n\u0131n ise %3.4 ile %11 aras\u0131nda seyretti\u011fi tahmin edilmektedir (2). COVID-19 pandemisinde k\u00fcresel olarak yatakl\u0131 tedavi hizmeti gerektiren hasta y\u00fck\u00fcn\u00fcn fazla olmas\u0131 t\u0131bbi kaynaklar\u0131n daha h\u0131zl\u0131 t\u00fcketimine sebep oldu\u011fu i\u00e7in sa\u011fl\u0131k sistemine fazladan y\u00fck olu\u015fturmaktad\u0131r.<\/p>\n

COVID-19 infeksiyonunda yo\u011fun bak\u0131ma yat\u0131\u015f ve mortalite a\u00e7\u0131s\u0131ndan hangi hastalar\u0131n risk alt\u0131nda oldu\u011funu belirlemek olduk\u00e7a \u00f6nemlidir (4). Risk fakt\u00f6rleri; ya\u015f, cinsiyet ve etnik k\u00f6ken gibi demografik fakt\u00f6rlerden beslenme ve ya\u015fam tarz\u0131 al\u0131\u015fkanl\u0131klar\u0131na, altta yatan hastal\u0131klara ve genetik fakt\u00f6rlere varan \u00e7e\u015fitlilik g\u00f6stermektedir (5). A\u011f\u0131r seyir g\u00f6sterecek hastalara ait demografik, klinik ve laboratuvar verilerin tan\u0131mlanmas\u0131, klinisyenlere erken tedaviden fayda sa\u011flayacak hastalar\u0131 belirlemede yol g\u00f6stermesinin yan\u0131 s\u0131ra, COVID-19 ile m\u00fccadelede geli\u015ftirilecek stratejiler a\u00e7\u0131s\u0131ndan faydal\u0131 olacakt\u0131r. COVID-19 infeksiyonunda a\u011f\u0131r klinik seyir ve \u00f6l\u00fcm\u00fc \u00f6ng\u00f6ren risk fakt\u00f6rleri ile ilgili yap\u0131lm\u0131\u015f uluslararas\u0131 \u00e7al\u0131\u015fmalar olmakla birlikte, bu konu hakk\u0131nda \u00fclkemizden yap\u0131lm\u0131\u015f k\u0131s\u0131tl\u0131 say\u0131da \u00e7al\u0131\u015fma bulunmaktad\u0131r. Bu nedenle \u00e7al\u0131\u015fmam\u0131zda COVID-19 infeksiyonu nedeniyle hastaneye yat\u0131r\u0131larak izlenen hastalarda yo\u011fun bak\u0131ma yat\u0131\u015f\u0131 ve mortaliteyi etkileyen fakt\u00f6rleri belirlemeyi ama\u00e7lad\u0131k.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

\u0130zmir Katip \u00c7elebi \u00dcniversitesi Atat\u00fcrk E\u011fitim ve Ara\u015ft\u0131rma Hastanesi\u2019ne 1 May\u0131s 2020-1 A\u011fustos 2020 tarihleri aras\u0131nda ba\u015fvuran ve COVID-19 infeksiyonu nedeniyle servise yat\u0131r\u0131larak izlenen hastalar\u0131n demografik, klinik ve laboratuvar verileri geriye d\u00f6n\u00fck olarak de\u011ferlendirildi. \u00c7al\u0131\u015fmam\u0131z, T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 COVID-19 Bilimsel Ara\u015ft\u0131rma De\u011ferlendirme Komisyonu ve \u0130zmir Katip \u00c7elebi \u00dcniversitesi Giri\u015fimsel Olmayan Klinik Ara\u015ft\u0131rmalar Etik Kurulu taraf\u0131ndan onayland\u0131. T\u00fcm hastalar\u0131n takibi, tedavisi ve yo\u011fun bak\u0131ma al\u0131nma endikasyonu \u00e7al\u0131\u015fma periyodu i\u00e7inde g\u00fcncel olan T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 COVID-19 Rehberi\u2019ne (6) g\u00f6re belirlendi. Ayaktan takip edilen hastalar, 18 ya\u015f\u0131n alt\u0131nda olan hastalar, ger\u00e7ek zamanl\u0131 ters transkripsiyon polimeraz zincir reaksiyonu (RT-PCR) testi sonucuna g\u00f6re SARS-CoV-2 RNA\u2019s\u0131 negatif saptanan hastalar ve COVID-19 d\u0131\u015f\u0131nda infeksiyon hastal\u0131\u011f\u0131 \u015f\u00fcphesi olan hastalar \u00e7al\u0131\u015fma d\u0131\u015f\u0131 b\u0131rak\u0131ld\u0131. Hastane yat\u0131\u015f\u0131 s\u0131ras\u0131nda yo\u011fun bak\u0131ma yat\u0131r\u0131lan ya da \u00f6len hastalar \u00e7al\u0131\u015fma grubu, serviste takibi devam eden ve sa\u011f kalan hastalar ise kontrol grubu olarak al\u0131nd\u0131. \u00c7al\u0131\u015fmaya al\u0131nan hastalar\u0131n hastane yat\u0131\u015f\u0131n\u0131n ilk g\u00fcn\u00fcnde elde edilen laboratuvar verileri de\u011ferlendirildi. Elde edilen veriler COVID-19 infeksiyonu olan hastalarda yo\u011fun bak\u0131ma yat\u0131\u015f\u0131 ve mortaliteyi \u00f6ng\u00f6rme a\u00e7\u0131s\u0131ndan istatistiksel olarak de\u011ferlendirildi.<\/p>\n

\u0130statistiksel Analiz<\/h3>\n

\u00c7al\u0131\u015fmada elde edilen verilerin de\u011ferlendirilmesinde SPSS (\u201cStatistical Package for the Social Sciences\u201d) versiyon 22.0 program\u0131 (IBM Corp., Armonk, NY, ABD) kullan\u0131ld\u0131. De\u011fi\u015fkenlerin normal da\u011f\u0131l\u0131m kontrol\u00fc Shapiro-Wilk testi ile belirlendi. Tan\u0131mlay\u0131c\u0131 analiz sonu\u00e7lar\u0131; normal da\u011f\u0131lan de\u011fi\u015fkenler i\u00e7in ortalama ve standart sapma, normal da\u011f\u0131lmayan de\u011fi\u015fkenler i\u00e7in medyan ve %25-%75 y\u00fczdelikler olarak verildi. \u00c7al\u0131\u015fma ve kontrol gruplar\u0131 aras\u0131nda normal da\u011f\u0131l\u0131m g\u00f6steren s\u00fcrekli de\u011fi\u015fkenler i\u00e7in Student t testi; normal da\u011f\u0131l\u0131ma uymayan de\u011fi\u015fkenler i\u00e7in Mann-Whitney U testi; kategorik de\u011fi\u015fkenler i\u00e7in \u03c72 ve Fisher kesin \u03c72 testi kullan\u0131ld\u0131. P<\/i><\/span> de\u011ferinin 0.05\u2019ten k\u00fc\u00e7\u00fck olmas\u0131 istatistiksel olarak anlaml\u0131 kabul edildi.<\/p>\n

BULGULAR<\/h2>\n

\u00c7al\u0131\u015fmaya toplam 473 hasta dahil edildi. Hastalar\u0131n medyan ya\u015f\u0131 53 y\u0131l (40-68 ya\u015f) olup 269 (%56.9) hasta erkekti. Takipte 93 (%19.7) hasta yo\u011fun bak\u0131m \u00fcnitesine yat\u0131r\u0131ld\u0131. Takip verileri mevcut olan 468 hastadan 62 (%13.2)\u2019si \u00f6ld\u00fc. \u00d6len t\u00fcm hastalar yo\u011fun bak\u0131m \u00fcnitesinde izlenen hastalardan olu\u015fmaktayd\u0131.<\/p>\n

Klinik Hastal\u0131k Durumu<\/h3>\n

Hastalar\u0131n 208 (%44)\u2019inde en az bir kronik hastal\u0131k bulunmaktayd\u0131. Bu hastalar\u0131n 83 (%17.5)\u2019\u00fcnde diyabet, 108 (%22.8)\u2019inde hipertansiyon, 43 (%9.1)\u2019\u00fcnde kronik kalp hastal\u0131\u011f\u0131, 40 (%8.4)\u2019\u0131nda kronik akci\u011fer hastal\u0131\u011f\u0131, 27 (%5.7)\u2019sinde kronik b\u00f6brek yetmezli\u011fi, 14 (%3)\u2019\u00fcnde malignite ve 10 (%2.1)\u2019unda serebrovask\u00fcler hastal\u0131k bulunmaktayd\u0131.<\/p>\n

Klinik Bulgular<\/h3>\n

Hastaneye yat\u0131\u015f s\u0131ras\u0131nda var olan bulgular de\u011ferlendirildi\u011finde; 111 (%23.5) hastada ate\u015f, 162 (%34.2) hastada \u00f6ks\u00fcr\u00fck, 47 (%9.9) hastada kas a\u011fr\u0131s\u0131, 80 (%16.9) hastada nefes darl\u0131\u011f\u0131 ve 9 (%1.9) hastada ishal bulunmaktayd\u0131.<\/p>\n

Laboratuvar Bulgular\u0131<\/h3>\n

T\u00fcm hastalar\u0131n %10.1 (46\/455)\u2019inde l\u00f6kopeni (<4 K\/ml), %13.2 (60\/455)\u2019sinde l\u00f6kositoz (>11 K\/ml), %24.8 (113\/455)\u2019inde anemi (kad\u0131nlarda 12 g\/dl, erkeklerde 13 g\/dl alt\u0131), %14.9 (68\/455)\u2019unda trombositopeni (<150 K\/ml), %14.5 (28\/193)\u2019inde troponin y\u00fcksekli\u011fi (>0.02 ng\/ml), %55.2 (244\/442)\u2019sinde C-reaktif protein (CRP) y\u00fcksekli\u011fi (>10 mg\/l), %8.5 (19\/223)\u2019sinde prokalsitonin y\u00fcksekli\u011fi (>0.5 ng\/ml) mevcuttu. Ferritin d\u00fczeyi 500 ng\/ml \u00fcst\u00fcnde olan hasta oran\u0131 %15 (14\/93) iken D-dimer d\u00fczeyi 1000 ng\/ml \u00fcst\u00fcnde bulunan hasta oran\u0131 %6.5 (15\/230)\u2019ti.<\/p>\n

Yo\u011fun Bak\u0131ma Yat\u0131\u015f Risk Fakt\u00f6rleri<\/h3>\n
\"\"<\/a>

Tablo 1.<\/strong> COVID-19 \u0130nfeksiyonu Nedeniyle Hastaneye Yat\u0131r\u0131larak \u0130zlenen Hastalarda Yo\u011fun Bak\u0131ma Yat\u0131\u015f\u0131 ve \u00d6l\u00fcm\u00fc G\u00f6steren Klinik ve Laboratuvar Bulgular\u0131<\/p><\/div>\n

Takipte 93 (%19.7) hasta yo\u011fun bak\u0131m \u00fcnitesine yat\u0131r\u0131ld\u0131. \u0130leri ya\u015ftaki hastalar\u0131n yo\u011fun bak\u0131ma al\u0131nma oranlar\u0131 daha y\u00fcksek bulundu (p<\/i><\/span><0.001). Cinsiyet ve sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 olmak yo\u011fun bak\u0131ma yat\u0131\u015f a\u00e7\u0131s\u0131ndan anlaml\u0131 risk fakt\u00f6rleri olarak bulunmad\u0131 (Tablo 1).<\/p>\n

En az bir kronik hastal\u0131\u011f\u0131 olan hastalar\u0131n yo\u011fun bak\u0131ma yat\u0131\u015f oranlar\u0131 daha y\u00fcksek saptand\u0131 (p<\/i><\/span><0.001). Diyabet, kronik akci\u011fer hastal\u0131\u011f\u0131, kronik b\u00f6brek hastal\u0131\u011f\u0131, kronik kalp hastal\u0131\u011f\u0131, malignite ve serebrovask\u00fcler hastal\u0131k \u00f6yk\u00fcs\u00fc olan hastalarda yo\u011fun bak\u0131ma yat\u0131\u015f oranlar\u0131 daha y\u00fcksek bulundu. Hipertansiyonu ve kronik karaci\u011fer hastal\u0131\u011f\u0131 bulunan hastalarda yo\u011fun bak\u0131ma yat\u0131\u015f oranlar\u0131 benzerdi (Tablo 1).<\/p>\n

Yo\u011fun bak\u0131ma yatan hastalarda, hastaneye ba\u015fvuru s\u0131ras\u0131nda nefes darl\u0131\u011f\u0131 daha y\u00fcksek oranda g\u00f6zlendi (p<\/i><\/span><0.001). \u00d6ks\u00fcr\u00fck ve kas a\u011fr\u0131s\u0131 varl\u0131\u011f\u0131nda yo\u011fun bak\u0131ma yat\u0131\u015f oran\u0131 daha y\u00fcksek bulundu (p<\/i><\/span>=0.002 ve p<\/i><\/span>=0.016). Ate\u015f ve ishal g\u00f6r\u00fclme oranlar\u0131 yo\u011fun bak\u0131mda yatan ya da serviste izlenen hastalar aras\u0131nda benzerdi (Tablo 1).<\/p>\n

Laboratuvar bulgular\u0131na g\u00f6re; glukoz, AST, kreatinin, direkt bilirubin, alb\u00fcmin, CRP, prokalsitonin, l\u00f6kosit, lenfosit, n\u00f6trofil, hemoglobin, troponin, D-dimer, ferritin, protrombin zaman\u0131 ve INR (\u201cinternational normalized ratio\u201d) seviyeleri yo\u011fun bak\u0131ma yat\u0131\u015f ile ili\u015fkili parametreler olarak saptand\u0131 (Tablo 1).<\/p>\n

Mortalite Risk Fakt\u00f6rleri<\/h3>\n

Takip verileri mevcut olan 468 hastadan 62 (%13.2)\u2019si \u00f6ld\u00fc. \u0130leri ya\u015ftaki hastalar\u0131n \u00f6l\u00fcm oranlar\u0131 daha y\u00fcksekti (p<\/i><\/span><0.001). Cinsiyet ve sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 olmak mortalite a\u00e7\u0131s\u0131ndan anlaml\u0131 bulunmad\u0131 (Tablo 1).<\/p>\n

En az bir kronik hastal\u0131\u011f\u0131 olan hastalar\u0131n \u00f6l\u00fcm oran\u0131 daha y\u00fcksek saptand\u0131 (p<\/i><\/span><0.001). Diyabet, kronik b\u00f6brek hastal\u0131\u011f\u0131, kronik kalp hastal\u0131\u011f\u0131, malignite ve serebrovask\u00fcler hastal\u0131k \u00f6yk\u00fcs\u00fc olan hastalarda \u00f6l\u00fcm oranlar\u0131 daha y\u00fcksek bulundu. Ancak kronik akci\u011fer hastal\u0131\u011f\u0131na sahip olmak mortalite a\u00e7\u0131s\u0131ndan anlaml\u0131 bulunmad\u0131. Hipertansiyonu ve kronik karaci\u011fer hastal\u0131\u011f\u0131 bulunan hastalarda sa\u011fkal\u0131m ve \u00f6l\u00fcm oranlar\u0131 benzerdi (Tablo 1).<\/p>\n

\u00d6len hastalarda hastaneye ba\u015fvuru s\u0131ras\u0131nda nefes darl\u0131\u011f\u0131 daha y\u00fcksek oranda g\u00f6zlendi (p<\/i><\/span><0.001); kas a\u011fr\u0131s\u0131 g\u00f6r\u00fclme oran\u0131 sa\u011f kalan hastalara k\u0131yasla daha d\u00fc\u015f\u00fck iken (p<\/i><\/span>=0.020), \u00f6ks\u00fcr\u00fck \u015fikayeti benzer orandayd\u0131. Ate\u015f ve ishal, sa\u011f kalan ve \u00f6len hastalarda benzer oranda saptand\u0131 (Tablo 1).<\/p>\n

\u00d6len hastalar\u0131n yo\u011fun bak\u0131mda ortalama yat\u0131\u015f g\u00fcnleri sa\u011f kalan hastalardan daha y\u00fcksek olsa da bu farkl\u0131l\u0131k anlaml\u0131 bulunmad\u0131 (2.2\u00b14.3 g\u00fcn ve 1.9\u00b12.3 g\u00fcn; p<\/i><\/span>=0.856). Laboratuvar bulgular\u0131na g\u00f6re; glukoz, AST, kreatinin, direkt bilirubin, alb\u00fcmin, CRP, prokalsitonin, l\u00f6kosit, lenfosit, n\u00f6trofil, hemoglobin, troponin, D-dimer, ferritin, protrombin zaman\u0131 ve INR seviyeleri mortalite ile ili\u015fkili parametreler olarak saptand\u0131 (Tablo 1).<\/p>\n

\u0130RDELEME<\/h2>\n

COVID-19 pandemisi t\u00fcm d\u00fcnyay\u0131 etkisi alt\u0131na alarak asemptomatik seyirden \u00f6l\u00fcme kadar seyredebilen \u00e7e\u015fitli klinik tablolar ile milyonlarca olguya ve \u00f6l\u00fcme sebep olmu\u015ftur (4). COVID-19 infeksiyonu olan hastalar\u0131n yakla\u015f\u0131k %14\u2019\u00fcn\u00fcn a\u011f\u0131r ve %6\u2019s\u0131n\u0131n yo\u011fun bak\u0131m izlemi gerektiren kritik hastal\u0131\u011fa sahip olmas\u0131 nedeniyle t\u00fcm olgular\u0131n yakla\u015f\u0131k %20\u2019sinin hastanede yatarak izlenmesi gerekti\u011fi tahmin edilmektedir (7). Ortalama olgu \u00f6l\u00fcm oran\u0131n\u0131n ise %2.5 civar\u0131nda seyretti\u011fi bildirilmektedir (1). Hastaneye yat\u0131r\u0131lan hastalar\u0131n irdelendi\u011fi bir meta-analiz \u00e7al\u0131\u015fmas\u0131nda ortalama olgu \u00f6l\u00fcm oran\u0131 %13 olarak g\u00f6sterilmi\u015ftir (8). Hastaneye yatan kritik durumda olan hastalarda ise bu oran\u0131n %49\u2019a ula\u015fabildi\u011fi belirtilmi\u015ftir (9). \u00c7al\u0131\u015fmam\u0131z\u0131n sonu\u00e7lar\u0131, hastaneye yat\u0131r\u0131lm\u0131\u015f hastalar\u0131n yakla\u015f\u0131k be\u015fte birinde yo\u011fun bak\u0131ma yat\u0131\u015f gereklili\u011fi oldu\u011funu ve bu hastalar\u0131n yar\u0131s\u0131ndan fazlas\u0131n\u0131n ise \u00f6ld\u00fc\u011f\u00fcn\u00fc g\u00f6sterdi. Genel durumu iyi olmas\u0131 nedeniyle ayaktan takip edilen ve bu nedenle \u00e7al\u0131\u015fmam\u0131za dahil edilmemi\u015f olan olgular nedeniyle hastanede yatarak izlenmi\u015f hastalar\u0131m\u0131zda yo\u011fun bak\u0131ma yat\u0131\u015f ve \u00f6l\u00fcm oranlar\u0131n\u0131n y\u00fcksek olmas\u0131 \u015fa\u015f\u0131rt\u0131c\u0131 de\u011fildir. Yine de hastanemizin, bulundu\u011fu b\u00f6lgede referans hastane olarak g\u00f6rev almas\u0131, bu nedenle \u00f6zellikle durumu kritik olan hastalar\u0131n hastanemize y\u00f6nlendirilmesi yo\u011fun bak\u0131ma yat\u0131\u015f ve \u00f6l\u00fcm oranlar\u0131n\u0131n g\u00f6rece y\u00fcksek olu\u015funu a\u00e7\u0131klayabilir. Hastaneye yat\u0131\u015f gereklili\u011fi, a\u011f\u0131r hastal\u0131k ve \u00f6l\u00fcm oranlar\u0131n\u0131n y\u00fcksek olu\u015fu nedeni ile COVID-19 pandemisi k\u00fcresel olarak \u00f6nem arz etmeye devam etmektedir.<\/p>\n

\u0130leri ya\u015f\u0131n, COVID-19\u2019a ba\u011fl\u0131 mortalitenin \u00f6nemli bir g\u00f6stergesi oldu\u011fu bildirilmektedir (10-12). COVID-19 infeksiyonu nedeniyle hastanede yatarak izlenen 2968 hastan\u0131n incelendi\u011fi bir \u00e7al\u0131\u015fmada, ya\u015fta her bir y\u0131ll\u0131k art\u0131\u015f\u0131n \u00f6l\u00fcm olas\u0131l\u0131\u011f\u0131n\u0131 %5 oran\u0131nda art\u0131rd\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir (10). Wang ve arkada\u015flar\u0131 (11), hastaneye yat\u0131r\u0131larak izlenen 65 ya\u015f ve \u00fczerinde olan hastalarda mortalite risk katsay\u0131s\u0131n\u0131n 2 kata yak\u0131n artt\u0131\u011f\u0131n\u0131 belirtmi\u015flerdir. \u00c7al\u0131\u015fmam\u0131zda ileri ya\u015fta yo\u011fun bak\u0131ma yat\u0131\u015f ve \u00f6l\u00fcm oranlar\u0131n\u0131n daha fazla oldu\u011funu, hatta 65 ya\u015f ve \u00fcst\u00fcnde bu oran\u0131n olduk\u00e7a y\u00fckselmi\u015f oldu\u011funu g\u00f6sterdik. \u0130leri ya\u015f grubunda, ba\u011f\u0131\u015f\u0131kl\u0131k sistemindeki fizyolojik de\u011fi\u015fimler ve e\u015flik eden hastal\u0131klar\u0131n fazla olu\u015fu bu durumun \u00f6nde gelen sebeplerinden olabilir (12). COVID-19 infeksiyonuna ba\u011fl\u0131 yo\u011fun bak\u0131ma yat\u0131\u015f ve \u00f6l\u00fcm oranlar\u0131 ile ilgili farkl\u0131 merkezlerden bildirilen y\u00fcksek oranlar, COVID-19 infeksiyonunda potansiyel risk fakt\u00f6rlerinin tan\u0131mlanmas\u0131n\u0131n gereklili\u011fini g\u00f6stermektedir.<\/p>\n

E\u015flik eden komorbiditelerin, COVID-19 infeksiyonunda morbidite ve mortalite ile ili\u015fkili oldu\u011fu bildirilmektedir (13, 14). COVID-19 infeksiyonu olan 14 558 hastan\u0131n irdelendi\u011fi bir meta-analiz \u00e7al\u0131\u015fmas\u0131nda; komorbid hastal\u0131k prevalans\u0131 hipertansiyon i\u00e7in %22.9, diyabet i\u00e7in %11.5, kardiyovask\u00fcler hastal\u0131k i\u00e7in %9.7 iken kronik obstr\u00fcktif akci\u011fer hastal\u0131\u011f\u0131, kronik b\u00f6brek yetmezli\u011fi, serebrovask\u00fcler hastal\u0131k ve malignite i\u00e7in %4\u2019\u00fcn alt\u0131nda bulunmu\u015ftur. Ayr\u0131ca diyabet, hipertansiyon, kardiyovask\u00fcler hastal\u0131k, kronik obstr\u00fcktif akci\u011fer hastal\u0131\u011f\u0131, kronik b\u00f6brek yetmezli\u011fi ve malignite varl\u0131\u011f\u0131nda a\u011f\u0131r COVID-19 infeksiyonu riskinin artt\u0131\u011f\u0131; kronik obstr\u00fcktif akci\u011fer hastal\u0131\u011f\u0131, serebrovask\u00fcler hastal\u0131k, kardiyovask\u00fcler hastal\u0131k, kronik b\u00f6brek yetmezli\u011fi ve malignite varl\u0131\u011f\u0131nda ise mortalite riskinin artt\u0131\u011f\u0131 belirtilmi\u015ftir. S\u00f6z konusu meta-analiz \u00e7al\u0131\u015fmas\u0131nda, a\u011f\u0131r COVID-19 infeksiyonu geli\u015fimi riski a\u00e7\u0131s\u0131ndan serebrovask\u00fcler hastal\u0131k, \u00f6l\u00fcm riski a\u00e7\u0131s\u0131ndan diyabet ve hipertansiyon varl\u0131\u011f\u0131 anlaml\u0131 bulunmam\u0131\u015f olsa da bu durumun ger\u00e7ek bir ili\u015fki olmamas\u0131ndan ziyade kan\u0131t eksikli\u011finden kaynaklanabilece\u011fi ve daha fazla ara\u015ft\u0131rmaya ihtiya\u00e7 oldu\u011fu belirtilmi\u015ftir (14). \u00c7al\u0131\u015fmam\u0131z\u0131n bulgular\u0131ndaki, a\u011f\u0131r hastal\u0131k ve \u00f6l\u00fcm a\u00e7\u0131s\u0131ndan risk art\u0131\u015f\u0131n\u0131 g\u00f6steren diyabet, kronik b\u00f6brek hastal\u0131\u011f\u0131, kronik kalp hastal\u0131\u011f\u0131, malignite, serebrovask\u00fcler hastal\u0131k ve kronik akci\u011fer hastal\u0131\u011f\u0131 varl\u0131\u011f\u0131, devam eden pandemide y\u00fcksek riskli hastalar\u0131n belirlenmesinde hedef al\u0131nacak pop\u00fclasyonu i\u015faret etmektedir. Belirtilen ek hastal\u0131\u011f\u0131 olan COVID-19 infeksiyonu olan hastalar\u0131n, a\u011f\u0131r hastal\u0131k ve \u00f6l\u00fcm a\u00e7\u0131s\u0131ndan y\u00fcksek risk alt\u0131nda olmalar\u0131 sebebiyle geleneksel koruyucu \u00f6nlemlerin yan\u0131 s\u0131ra a\u015f\u0131lama politikalar\u0131nda \u00f6ncelikli olmas\u0131 gereken y\u00fcksek riskli grubu temsil etti\u011fini d\u00fc\u015f\u00fcnmekteyiz.<\/p>\n

COVID-19 ile infekte hastalarda, a\u011f\u0131r klinik seyir nedeniyle hastanede izlenme ihtiyac\u0131n\u0131n y\u00fcksek olmas\u0131, hastal\u0131k \u015fiddeti ve mortalite ile ili\u015fkili klinik ve laboratuvar bulgular\u0131n tan\u0131mlanmas\u0131n\u0131n gereklili\u011fini ortaya koymaktad\u0131r. Klinik bulgular ve laboratuvar parametreleri; hastal\u0131\u011f\u0131n \u015fiddetini de\u011ferlendirmede, prognozu tahmin etmede, hastalar\u0131n takibinde, tedavi se\u00e7iminde ve tedavi yan\u0131t\u0131n\u0131 izlemede yayg\u0131n olarak kullan\u0131lmaktad\u0131r. Klinik bulgulardan biri olarak nefes darl\u0131\u011f\u0131n\u0131n varl\u0131\u011f\u0131, a\u011f\u0131r seyir i\u00e7in bir\u00e7ok \u00e7al\u0131\u015fmada ortak bulgu olarak an\u0131lmaktad\u0131r (15). Hematolojik ve biyokimyasal parametrelerin yan\u0131 s\u0131ra koag\u00fclasyon de\u011ferlerinde bozulman\u0131n, k\u00f6t\u00fc gidi\u015fat\u0131 olan COVID-19 infeksiyonu hastalar\u0131nda daha s\u0131k saptand\u0131\u011f\u0131 belirtilmektedir (12-16). \u00c7al\u0131\u015fmam\u0131zda; yo\u011fun bak\u0131m takibi gereken ve \u00f6len hastalar\u0131m\u0131zda, hastaneye kabul s\u0131ras\u0131nda nefes darl\u0131\u011f\u0131n\u0131n daha s\u0131k saptanm\u0131\u015f olmas\u0131n\u0131n yan\u0131 s\u0131ra hematolojik, b\u00f6brek ve karaci\u011fer fonksiyonlar\u0131n\u0131 g\u00f6steren biyokimyasal, koag\u00fclasyon parametre d\u00fczeylerinin ve infeksiyon belirte\u00e7lerinin iyi seyir g\u00f6steren hastalara k\u0131yasla daha bozuk oldu\u011funu g\u00f6sterdik. Hastal\u0131\u011f\u0131n seyrini \u00f6ng\u00f6ren potansiyel klinik ve laboratuvar parametrelerinin belirlenmesi; \u015fiddetli klinik tablo ile seyretme potansiyeli olan hastalar\u0131n belirlenmesinde, tedaviyi ki\u015fiselle\u015ftirmede ve klinik ilerlemeyi izleyerek t\u00fcm bak\u0131m seviyelerinde uygun kaynaklar\u0131 sa\u011flamada fayda sa\u011flayabilir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131z\u0131n baz\u0131 k\u0131s\u0131tl\u0131l\u0131klar\u0131 bulunmaktad\u0131r. Bunlar; \u00e7al\u0131\u015fmam\u0131z\u0131n geriye d\u00f6n\u00fck olarak planlanm\u0131\u015f olmas\u0131, tek bir merkezde izlenen hastalar\u0131n \u00e7al\u0131\u015fmaya dahil edilmesi, baz\u0131 hastalar\u0131n ba\u015fka merkeze sevki nedeniyle ak\u0131betleri ile ilgili bilgiye ula\u015f\u0131lamamas\u0131 ve veri setinde var olan eksik veriler nedeniyle risk fakt\u00f6r\u00fc olarak belirlenen fakt\u00f6rlerin birbiri ile ili\u015fkisinin irdelenememesidir.<\/p>\n

Sonu\u00e7 olarak; sa\u011fl\u0131k hizmetlerinin sonu\u00e7lar\u0131n\u0131 iyile\u015ftirmek i\u00e7in COVID-19 hastal\u0131\u011f\u0131nda a\u011f\u0131r seyri \u00f6ng\u00f6ren fakt\u00f6rlerin tan\u0131mlanmas\u0131 gerekmektedir. Ya\u015f, e\u015flik eden komorbid hastal\u0131klar, klinik bulgular, tan\u0131sal belirte\u00e7ler ve organ i\u015flev bozuklu\u011fu g\u00f6stergeleri gibi fakt\u00f6rler kritik seyir g\u00f6sterecek hastalar\u0131n belirlenmesinde kullan\u0131labilir. Bununla birlikte, SARS-CoV-2\u2019nin ba\u015fta solunum yolu olmak \u00fczere bir\u00e7ok dokuda tutulum yapmas\u0131 COVID-19 hastal\u0131\u011f\u0131n\u0131n ciddiyetini tahmin etmeyi zorla\u015ft\u0131rmaktad\u0131r. COVID-19 infeksiyonunda komplikasyonlar\u0131 \u00f6ng\u00f6ren fakt\u00f6rlerin belirlenmesi, klinik yakla\u015f\u0131m\u0131 y\u00f6nlendirmek, hastal\u0131k seyrini iyile\u015ftirmek ve k\u0131s\u0131tl\u0131 olan kaynaklar\u0131 do\u011fru kullanmak a\u00e7\u0131s\u0131ndan olduk\u00e7a \u00f6nemlidir. Ek olarak risk fakt\u00f6rlerinin belirlenmesi, COVID-19 infeksiyonuna ait patofizyolojik s\u00fcre\u00e7lerin ayd\u0131nlat\u0131lmas\u0131na ve olas\u0131 tedavi stratejilerinin geli\u015ftirilmesine katk\u0131da bulunabilir.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Ciddi akut solunum sendromu koronavirus-2 (SARS-CoV-2) etkeni ile geli\u015fen koronavirus hastal\u0131\u011f\u0131 2019 (COVID-19) infeksiyonunun neden oldu\u011fu pandemi t\u00fcm d\u00fcnyadaki etkisini s\u00fcrd\u00fcrmektedir (1). COVID-19 infeksiyonun seyri, hastalarda klinik asemptomatik seyirden kritik hastal\u0131\u011fa ba\u011fl\u0131 \u00f6l\u00fcme kadar de\u011fi\u015fen \u00e7e\u015fitlilik g\u00f6stermektedir (1). A\u011f\u0131r COVID-19 infeksiyonu olan hastalarda; nefes darl\u0131\u011f\u0131, y\u00fcksek solunum say\u0131s\u0131, d\u00fc\u015f\u00fck oksijen sat\u00fcrasyonu ve yayg\u0131n akci\u011fer […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5174,2997,3767],"class_list":["post-24753","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-covid-19","tag-mortalite","tag-yogun-bakim-unitesi"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24753","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\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=24753"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24753\/revisions"}],"predecessor-version":[{"id":24858,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24753\/revisions\/24858"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=24753"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=24753"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=24753"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}