{"id":25827,"date":"2022-11-17T11:47:45","date_gmt":"2022-11-17T08:47:45","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=25827"},"modified":"2022-12-26T17:55:52","modified_gmt":"2022-12-26T14:55:52","slug":"covid-19da-viral-yukun-degerlendirilmesi","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2022\/11\/17\/covid-19da-viral-yukun-degerlendirilmesi\/","title":{"rendered":"COVID-19 Hastalar\u0131nda Hastal\u0131k \u015eiddeti ile Viral D\u00f6ng\u00fc E\u015fik De\u011feri Aras\u0131ndaki \u0130li\u015fkinin De\u011ferlendirilmesi"},"content":{"rendered":"

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

\u0130lk koronavirus hastal\u0131\u011f\u0131 2019 (COVID-19) olgusu \u00c7in\u2019in Vuhan kentinde te\u015fhis edilmi\u015ftir (1). COVID-19 olgular\u0131; asemptomatik seyir, pn\u00f6moni, akut solunum s\u0131k\u0131nt\u0131s\u0131 ve \u00e7oklu organ yetmezli\u011fi gibi farkl\u0131 klinik tablolar g\u00f6stermektedir (2). Benzer demografik \u00f6zelliklere sahip COVID-19 hastalar\u0131n\u0131n klinik seyrindeki farkl\u0131l\u0131klara bir\u00e7ok fakt\u00f6r\u00fcn sebep olabilece\u011fi g\u00f6sterilmi\u015ftir (3). COVID-19 baz\u0131 hastalarda \u00f6l\u00fcmc\u00fcl seyredebildi\u011finden, hekimlerin hastal\u0131\u011f\u0131n \u015fiddetini objektif olarak de\u011ferlendirmesinin yan\u0131 s\u0131ra olumlu ve olumsuz prognostik fakt\u00f6rleri bilmesi \u00f6nemlidir (4, 5).\u00a0<\/span><\/p>\n

Viral y\u00fck\u00fcn; influenza ve respiratuar sinsityal virus pn\u00f6monisi de dahil olmak \u00fczere bir\u00e7ok viral hastal\u0131kta hastal\u0131k \u015fiddetinin bir g\u00f6stergesi oldu\u011fu bildirilirken, literat\u00fcrde SARS-CoV-2 viral y\u00fck\u00fcn\u00fcn COVID-19 klinik \u015fiddetini tahmin etmedeki rol\u00fcne ili\u015fkin \u00e7eli\u015fkili bulgular mevcuttur (6-9). Polimeraz zincir reaksiyonu (\u201cpolymerase chain reaction \u2013 PCR\u201d), viral RNA e\u015fik de\u011ferini a\u015fan saptanabilir bir konsantrasyona ula\u015fana kadar \u00e7o\u011falt\u0131l\u0131r (8). Bunun ger\u00e7ekle\u015fmesi i\u00e7in gerekli olan d\u00f6ng\u00fc say\u0131s\u0131, d\u00f6ng\u00fc e\u015fik (\u201ccycle threshold \u2013 Ct\u201d) de\u011feridir.\u00a0Bu nedenle, bir hasta \u00f6rne\u011finin Ct de\u011feri ne kadar d\u00fc\u015f\u00fckse, viral y\u00fck o kadar y\u00fcksektir.<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131z, COVID-19 hastal\u0131k \u015fiddetini tahmin etmede SARS-CoV-2 viral y\u00fck\u00fcn\u00fcn rol\u00fcn\u00fc analiz etmeyi ama\u00e7lad\u0131. Ayr\u0131ca, laboratuvar verileri ve radyolojik \u015fiddet skorlamas\u0131 gibi potansiyel prognostik belirte\u00e7lerin rollerini de\u011ferlendirmeyi de ama\u00e7lad\u0131k.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

Hastalar<\/h3>\n

Hastanemizin COVID-19 poliklini\u011fine 01 May\u0131s \u2013 31 Haziran 2020 tarihleri \u200b\u200baras\u0131nda ba\u015fvuran eri\u015fkin (ya\u015f>18) hastalar de\u011ferlendirildi. Kombine burun ve bo\u011faz s\u00fcr\u00fcnt\u00fcs\u00fcnde PCR ile SARS-CoV-2 saptanan hastalara kesin tan\u0131 koyuldu ve \u00e7al\u0131\u015fmaya dahil edildi (10).\u00a0<\/span><\/p>\n

Demografik veriler, semptomlar, semptomlar\u0131n s\u00fcresi, yo\u011fun bak\u0131m \u00fcnitesine (YB\u00dc) sevk ve hastane i\u00e7i mortalite gibi klinik sonu\u00e7lar de\u011ferlendirildi. Laboratuvar verilerinden l\u00f6kosit, n\u00f6trofil, lenfosit, monosit ve trombosit say\u0131lar\u0131, C-reaktif protein (CRP), ferritin, magnezyum (Mg), kreatinin, laktat dehidrogenaz (LDH), aspartat aminotransferaz (AST), gama-glutamil transferaz (GGT), troponin ve D-dimer seviyeleri elektronik hasta kay\u0131tlar\u0131ndan al\u0131nd\u0131. T\u00fcm laboratuvar testleri PCR testi ile ayn\u0131 g\u00fcn yap\u0131ld\u0131.<\/p>\n

Hastalar, D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6)\u2019n\u00fcn s\u0131n\u0131fland\u0131rmas\u0131na uygun olarak hafif-orta veya \u015fiddetli klinik olarak iki gruba ayr\u0131ld\u0131; takipnesi \u226530\/dk ve oda havas\u0131nda SpO2 <\/sub>\u2264%90 olan hastalar \u015fiddetli klini\u011fe sahip olarak kabul edildi (11).\u00a0<\/span><\/p>\n

\u00c7al\u0131\u015fma i\u00e7in D\u00fczce \u00dcniversitesi Giri\u015fimsel Olmayan Sa\u011fl\u0131k Ara\u015ft\u0131rmalar\u0131 Etik Kurulu\u2019ndan 20 Temmuz 2020 tarih ve 2020\/156 karar numaras\u0131yla onay al\u0131nm\u0131\u015ft\u0131r.<\/p>\n

PCR\u00a0<\/span><\/h3>\n

Nazofaringeal s\u00fcr\u00fcnt\u00fc \u00f6rnekleri, uygun ta\u015f\u0131ma teknikleri ile laboratuvara g\u00f6nderildi. Virus varl\u0131\u011f\u0131n\u0131n tespitinde Bio-Speedy\u00ae<\/span> SARS CoV-2 RT-qPCR kiti (Bioeksen AR-GE Teknolojiler, T\u00fcrkiye) kullan\u0131ld\u0131. Virus RNA\u2019s\u0131n\u0131n varl\u0131\u011f\u0131 yar\u0131 nicel olarak de\u011ferlendirildi.\u00a0<\/span><\/p>\n

Ger\u00e7ek zamanl\u0131 PCR reaksiyonlar\u0131, numunedeki floresan miktar\u0131n\u0131 tespit ederek pozitifli\u011fi belirler (12) ve Ct de\u011feri, olu\u015fan floresan miktar\u0131n\u0131n, e\u015fik de\u011ferini a\u015ft\u0131\u011f\u0131 d\u00f6ng\u00fc say\u0131s\u0131d\u0131r. Ct de\u011feri ve hedef kopya say\u0131s\u0131 ters orant\u0131l\u0131 olup Ct ne kadar k\u00fc\u00e7\u00fckse, numunede o kadar fazla hedef n\u00fckleik asit bulunur. \u00c7al\u0131\u015fmam\u0131zda, reaksiyonlar, ger\u00e7ek zamanl\u0131 PCR analizleri s\u0131ras\u0131nda 40 d\u00f6ng\u00fc i\u00e7in \u00e7al\u0131\u015ft\u0131r\u0131ld\u0131; Ct<25 olmas\u0131, y\u00fcksek miktarda hedef n\u00fckleik asit oldu\u011funu g\u00f6steren g\u00fc\u00e7l\u00fc pozitif reaksiyon olarak kabul edildi. \u00d6te yandan, \u226525 olan de\u011ferler, orta ve minimum miktarda hedef n\u00fckleik asit g\u00f6steren orta-zay\u0131f reaksiyonlar olarak de\u011ferlendirildi. Klinik durum ile viral hedef kopya say\u0131s\u0131 aras\u0131ndaki potansiyel korelasyon analiz edildi (Ct<25 veya Ct\u226525).<\/p>\n

G\u00f6r\u00fcnt\u00fcleme Tekni\u011fi ve Yorumlama<\/h3>\n

T\u00fcm akci\u011fer bilgisayarl\u0131 tomografi (BT) g\u00f6r\u00fcnt\u00fcleri Activion\u2122<\/span> 16 (Toshiba Corp., Japonya) ile elde edildi. G\u00f6r\u00fcnt\u00fcleme parametreleri; 120 kVp gerilim ve 50-300 mAs otomatik ak\u0131\u015f mod\u00fclasyonu olarak belirlendi. G\u00f6r\u00fcnt\u00fcler akci\u011fer i\u00e7in WW (\u201cwindow width\u201d)=1600 \u201cHounsfield unit\u201d (HU) , WL (\u201cwindow level\u201d)= -600 HU; mediasten i\u00e7in W=400 HU, L=-40 HU pencere ayarlar\u0131yla de\u011ferlendirildi. PCR testi ile ayn\u0131 g\u00fcn akci\u011fer BT incelemeleri yap\u0131ld\u0131. G\u00f6r\u00fcnt\u00fc analizi, hastalar\u0131n klinik ve laboratuvar verilerine \u201ck\u00f6r\u201d bir radyolog taraf\u0131ndan G\u00f6r\u00fcnt\u00fc Ar\u015fivleme ve \u0130leti\u015fim Sistemi (\u201cPicture Archiving Communication System \u2013 PACS\u201d) i\u015f istasyonu kullan\u0131larak yap\u0131ld\u0131.\u00a0<\/span><\/p>\n

Akci\u011fer BT bulgular\u0131; COVID-19 pn\u00f6monisi i\u00e7in literat\u00fcrde tan\u0131mlanm\u0131\u015f buzlu cam opasiteleri, konsolidasyon, kavitasyon, tomurcuklu a\u011fa\u00e7, bron\u015f duvar\u0131 kal\u0131nla\u015fmas\u0131, traksiyon bron\u015fektazisi, retik\u00fcler patern, subplevral bantlar, vask\u00fcler geni\u015fleme ve plevral ef\u00fczyon a\u00e7\u0131s\u0131ndan de\u011ferlendirildi (12).\u00a0<\/span><\/p>\n

COVID-19\u2019da akci\u011fer tutulum paternlerinin derecesini de\u011ferlendiren yar\u0131 nicel bir \u00f6l\u00e7ek kullan\u0131ld\u0131 (13, 14). Bu \u00f6l\u00e7ekte, her bir akci\u011fer \u00fcst (karinan\u0131n \u00fcst\u00fcnde), orta ve alt (inferior pulmoner venin alt\u0131nda) olmak \u00fczere \u00fc\u00e7 b\u00f6lgeye ayr\u0131ld\u0131.\u00a0Her akci\u011fer b\u00f6lgesi i\u00e7in; 0=%0 tutulum, 1=%25\u2019ten az tutulum, 2=%25 ile %50\u2019den az tutulum, 3=%50 ile %75\u2019ten az tutulum ve 4=%75 veya daha fazla tutulum olarak skorland\u0131.\u00a0Genel BT skorlar\u0131, alt\u0131 akci\u011fer b\u00f6lgesinin t\u00fcm\u00fcnden al\u0131nan skorlar\u0131n toplam\u0131 olup 0 ile 24 aras\u0131ndayd\u0131.\u00a0<\/span><\/p>\n

\u0130statistiksel Analiz<\/h3>\n

T\u00fcm veriler ortalama \u00b1 standart sapmalar (SS) ve %95 g\u00fcven aral\u0131\u011f\u0131 (GA) olarak sunuldu. \u00c7eyrekler aras\u0131 aral\u0131klara sahip y\u00fczdeler ve medyanlar [IQR] uygun olan yerlerde hesapland\u0131. Verilerin normal da\u011f\u0131l\u0131m\u0131 Mann-Whitney U ve Pearson-\u03c7 2 testleri ile; normal da\u011f\u0131lmayan nicel veriler aras\u0131ndaki korelasyon ise Spearman korelasyon analizi ile de\u011ferlendirildi. \u015eiddetli klinik seyir ile ilgili fakt\u00f6rlerin belirlenmesinde ikili lojistik regresyon modeli kullan\u0131ld\u0131. \u0130statistiksel olarak p<\/i><0.05 de\u011ferleri anlaml\u0131 d\u00fczey olarak kabul edildi. \u201cCut-off\u201d Ct de\u011feri al\u0131c\u0131 \u00e7al\u0131\u015fma karakteristi\u011fi (\u201creceiver operating charateristics \u2013 ROC\u201d) e\u011frisi analizi ile belirlendi. Verilerin istatistiksel analizinde SPSS (\u201cStatistical Package for the Social Sciences\u201d) versiyon 23.0 program\u0131 (IBM Corp., ABD) kullan\u0131ld\u0131.<\/p>\n

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

Tablo 1.<\/strong> Klinik Seyir Baz\u0131nda Demografik, Klinik ve Radyolojik \u00d6zelliklerin Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n

\"\"<\/a>

Tablo 2.<\/strong> Farkl\u0131 Hastal\u0131k \u015eiddeti Olan Hastalar Aras\u0131nda Laboratuvar Verilerinin Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131<\/p><\/div>\n

\"\"<\/a>

Tablo 3.<\/strong> A\u011f\u0131r Klinik Seyir G\u00f6steren Hastalar \u0130\u00e7in Lojistik
Regresyon Analizi Sonu\u00e7lar\u0131<\/p><\/div>\n

\u00c7al\u0131\u015fmaya 285 hasta dahil edilmi\u015f olup 254\u2019\u00fcnde hafif-orta klinik seyir, 31\u2019inde ise \u015fiddetli seyir izlendi. Cinsiyet da\u011f\u0131l\u0131mlar\u0131 a\u00e7\u0131s\u0131ndan iki hasta grubu benzerdi; ilk grubun %53.1\u2019i, ikinci grubun %51.6\u2019s\u0131 kad\u0131nd\u0131. SARS-CoV-2 viral y\u00fck\u00fc ve semptom s\u00fcresi a\u00e7\u0131s\u0131ndan da gruplar benzerdi (p<\/i>>0.05) (Tablo 1). Ancak bu iki grup aras\u0131nda hasta ya\u015f\u0131 ve hastanede yat\u0131\u015f s\u00fcreleri a\u00e7\u0131s\u0131ndan anlaml\u0131 d\u00fczeyde fark saptand\u0131 (p<\/i><0.05) (Tablo 1). \u015eiddetli klinik seyri olan hastalarda akci\u011fer BT skorlar\u0131, D-dimer, \u00fcre, kreatinin, ferritin, AST, LDH, GGT, troponin, CRP, n\u00f6trofil de\u011ferleri hafif-orta seyirli olanlara g\u00f6re anlaml\u0131 d\u00fczeyde y\u00fcksekti (p<\/i><0.05) (Tablo 2). Tek de\u011fi\u015fkenli analize g\u00f6re klinik seyri etkileyen fakt\u00f6rler, lojistik regresyon analizi ile de de\u011ferlendirildi. Bu analiz, artan ferritin, LDH ve CRP d\u00fczeylerinin \u015fiddetli klinik seyirle ili\u015fkili oldu\u011funu ortaya koydu (p<\/i><0.05, \u201codds ratio\u201d (OR)=1.002, p<\/i><0.05, OR=1.002, p<\/i><0.05, OR=1.192) (Tablo 3).\u00a0<\/span><\/span><\/p>\n

\u0130RDELEME<\/h2>\n

\u00c7al\u0131\u015fmam\u0131zda d\u00fc\u015f\u00fck Ct de\u011ferlerinin, \u015fiddetli klinik seyir, yo\u011fun bak\u0131m \u00fcnitesine yat\u0131\u015f ve mortalite ile ili\u015fkili olmad\u0131\u011f\u0131n\u0131 tespit ettik. \u00d6zellikle hastalar\u0131n \u00f6rnek al\u0131nma zaman\u0131na kadar ge\u00e7en semptom s\u00fcrelerinin gruplar aras\u0131nda benzer olmas\u0131 yapm\u0131\u015f oldu\u011fumuz \u00e7\u0131kar\u0131m\u0131n g\u00fcvenilir yan\u0131n\u0131 ve literat\u00fcrdeki benzer \u00e7al\u0131\u015fmalara \u00fcst\u00fcnl\u00fc\u011f\u00fcn\u00fc g\u00f6stermektedir. \u00d6te yandan, ya\u015f, akci\u011fer BT skorlar\u0131, serum ferritin, LDH ve CRP d\u00fczeylerinin \u015fiddetli klinik seyir ile anlaml\u0131 \u015fekilde ili\u015fkili oldu\u011funu tespit ettik.\u00a0<\/span><\/span><\/p>\n

COVID-19 hastalar\u0131nda SARS-CoV-2 viral y\u00fck\u00fcn\u00fcn klinik \u00f6nemi belirsizli\u011fini korumaktad\u0131r. Klinik \u00e7al\u0131\u015fmalar viral y\u00fckteki art\u0131\u015f\u0131n olumsuz bir klinik seyir ile ili\u015fkili oldu\u011funu g\u00f6stermekle birlikte di\u011fer kohortlar ve postmortal \u00e7al\u0131\u015fmalar COVID-19 ile ili\u015fkili doku hasar\u0131n\u0131n ve klinik durumun Ct de\u011ferleri ile korele olmad\u0131\u011f\u0131n\u0131 bildirmi\u015ftir (8, 15-19). Literat\u00fcrdeki \u00e7al\u0131\u015fmalardan farkl\u0131 olarak Argyropoulos ve arkada\u015flar\u0131 (20), viral y\u00fck\u00fcn hastal\u0131k \u015fiddeti ile ters orant\u0131l\u0131 oldu\u011funu ve hafif COVID-19 hastalar\u0131nda \u015fiddetli COVID-19 hastalar\u0131na k\u0131yasla viral y\u00fck\u00fcn daha y\u00fcksek oldu\u011funu g\u00f6stermi\u015ftir. Bu \u00e7eli\u015fkili veriler b\u00fcy\u00fck olas\u0131l\u0131kla hastalar\u0131n semptom s\u00fcreleri ve \u00f6rnekleme tekni\u011fi farkl\u0131l\u0131\u011f\u0131ndan kaynaklanmaktad\u0131r.<\/p>\n

Fa\u00edco-Filho ve arkada\u015flar\u0131 (21), viral y\u00fckle, hastal\u0131k \u015fiddeti ve mortalite aras\u0131nda anlaml\u0131 bir ili\u015fki bulmu\u015f olup viral y\u00fck\u00fcn, COVID-19 hastalar\u0131nda prognostik bir fakt\u00f6r olarak kullan\u0131labilece\u011fini belirtmi\u015ftir. S\u00f6z konusu yazarlar viral Ct de\u011feri ile mortalite oran\u0131 aras\u0131nda bir ili\u015fki bulmu\u015ftur; ancak analizlerine semptom s\u00fcresi dahil edilmemi\u015ftir. Bu durum \u00e7al\u0131\u015fmalar\u0131n\u0131n bir s\u0131n\u0131rl\u0131l\u0131\u011f\u0131 olarak kabul edilebilir. Magleby ve arkada\u015flar\u0131 (22), daha y\u00fcksek viral y\u00fck\u00fcn artm\u0131\u015f ent\u00fcbasyon riski ve daha y\u00fcksek mortalite oranlar\u0131 ile ili\u015fkili oldu\u011funu belirtmi\u015ftir. Ancak viral y\u00fck\u00fc y\u00fcksek hastalarda, semptom s\u00fcresi 7 g\u00fcn iken, viral y\u00fck\u00fc d\u00fc\u015f\u00fck hastalarda bu s\u00fcre 8-10 g\u00fcnd\u00fcr. Bu bulgu, yazarlar taraf\u0131ndan da \u00e7al\u0131\u015fman\u0131n en \u00f6nemli s\u0131n\u0131rl\u0131l\u0131klar\u0131ndan biri olarak kabul edilmi\u015ftir. Huang ve arkada\u015flar\u0131 (23), periyodik Ct \u00f6l\u00e7\u00fcmleri yapm\u0131\u015f ve mortalitenin hastalar\u0131n klinik seyri s\u0131ras\u0131nda viral y\u00fckteki de\u011fi\u015fikliklerle ili\u015fkili oldu\u011funu saptam\u0131\u015ft\u0131r. Bununla birlikte, analizlerine \u00f6rnek al\u0131n\u0131ncaya kadar ge\u00e7en semptom s\u00fcresini dahil etmemi\u015flerdir. \u00d6te yandan Salto-Alejandre ve arkada\u015flar\u0131 (24), 321 hasta ile yap\u0131lan \u00e7al\u0131\u015fmalar\u0131nda, viral y\u00fck ile hastalar\u0131n klinik durumu aras\u0131nda anlaml\u0131 d\u00fczeyde bir ili\u015fki olmad\u0131\u011f\u0131n\u0131 bildirmi\u015ftir. Ayr\u0131ca viral y\u00fck\u00fcn mortalite riskiyle ili\u015fkili olmad\u0131\u011f\u0131n\u0131 da belirtmi\u015flerdir. Maltezou ve arkada\u015flar\u0131 (25), y\u00fcksek viral y\u00fck\u00fcn yo\u011fun bak\u0131ma sevk, mekanik ventilasyona gereksinim ve mortalite riskleri ile ili\u015fkisi olmad\u0131\u011f\u0131n\u0131 tespit etmi\u015ftir. Amodio ve arkada\u015flar\u0131 (26), yo\u011fun bak\u0131ma sevk edilen hastalarda Ct de\u011ferinin hastaneye yat\u0131r\u0131lmayanlara g\u00f6re anlaml\u0131 d\u00fczeyde d\u00fc\u015f\u00fck oldu\u011funu bildirmi\u015ftir. Ancak ya\u015f ve cinsiyet i\u00e7in d\u00fczeltme yap\u0131ld\u0131ktan sonra, Ct de\u011feri ile yo\u011fun bak\u0131m \u00fcnitesine sevk ve mortalite riski aras\u0131nda bir ili\u015fki bulamam\u0131\u015flard\u0131r.\u00a0<\/span><\/span><\/p>\n

COVID-19 hastal\u0131\u011f\u0131 s\u0131ras\u0131nda viral y\u00fck\u00fcn dinamik bir seyir izledi\u011fi bilinmektedir (27). \u00c7al\u0131\u015fmam\u0131zda, \u015fiddetli klinik ve hafif-orta klinik ile seyreden hasta gruplar\u0131 aras\u0131nda semptom s\u00fcreleri a\u00e7\u0131s\u0131ndan farkl\u0131l\u0131k bulamad\u0131k. Bu nedenle, viral y\u00fck ile klinik durum aras\u0131nda hi\u00e7bir ili\u015fki olmad\u0131\u011f\u0131na dair tespitimiz, daha \u00f6nce literat\u00fcrde bildirilen bulgulara g\u00f6re daha g\u00fcvenilirdir.\u00a0<\/span><\/span><\/p>\n

Baz\u0131 \u00e7al\u0131\u015fmalar, COVID-19\u2019lu hastalarda akci\u011fer BT bulgular\u0131na dayal\u0131 olarak akci\u011fer tutulumunun kapsam\u0131n\u0131 de\u011ferlendirmek i\u00e7in yar\u0131 nicel bir skorlama sisteminin kullan\u0131lmas\u0131n\u0131 desteklemektedir (28). \u00c7al\u0131\u015fmam\u0131zda akci\u011fer BT skoru da hastal\u0131k \u015fiddeti ile pozitif korelasyon g\u00f6sterdi.\u00a0<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, y\u00fcksek serum ferritin, CRP ve LDH d\u00fczeylerinin \u015fiddetli klinik seyir ile ili\u015fkili oldu\u011fu ortaya koyduk. Bu nedenle, s\u00f6z konusu bulgular COVID-19 hastalar\u0131nda k\u00f6t\u00fc prognostik fakt\u00f6rler olarak kabul edilebilir. Y\u00fcksek serum ferritin, CRP ve LDH d\u00fczeylerinin ciddi inflamasyon ve doku hasar\u0131n\u0131n g\u00f6stergesi oldu\u011fu bildirilmi\u015ftir (29-32). Bulgular\u0131m\u0131z bu \u00e7al\u0131\u015fmalarla uyumludur.<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131z\u0131n bulgular\u0131 de\u011ferlendirilirken dikkate al\u0131nmas\u0131 gereken baz\u0131 s\u0131n\u0131rl\u0131l\u0131klar mevcuttur. \u00d6ncelikli olarak, viral y\u00fck \u00f6l\u00e7\u00fcmleri ilk tan\u0131 s\u0131ras\u0131nda ve yaln\u0131zca bir kez yap\u0131ld\u0131; ard\u0131ndan gelen viral y\u00fckteki de\u011fi\u015fiklikler ve klinik sonu\u00e7lar \u00fczerindeki potansiyel etkiler de\u011ferlendirilmedi. \u0130kinci olarak, nazofaringeal s\u00fcr\u00fcnt\u00fcler ayn\u0131 sa\u011fl\u0131k personeli taraf\u0131ndan yap\u0131lmad\u0131. Ancak \u00f6rneklem b\u00fcy\u00fckl\u00fc\u011f\u00fcm\u00fcz\u00fcn yeterli olmas\u0131 ve \u00f6rnek al\u0131nma zaman\u0131na kadar ge\u00e7en semptom s\u00fcrelerinin gruplar aras\u0131nda benzer olmas\u0131 \u00e7al\u0131\u015fmam\u0131z\u0131n g\u00fc\u00e7l\u00fc taraflar\u0131yd\u0131.<\/p>\n

Sonu\u00e7 olarak; \u00e7al\u0131\u015fmam\u0131zda klinik seyrin \u015fiddetli veya hafif-orta d\u00fczeyde seyretmesi viral y\u00fck ile ili\u015fkisiz bulundu. Ayn\u0131 do\u011frultuda yo\u011fun bak\u0131m \u00fcnitesine yat\u0131\u015f ve mortaliteyi \u00f6ng\u00f6rme a\u00e7\u0131s\u0131ndan da viral y\u00fck kullan\u0131\u015fs\u0131z bulundu. Bunun yan\u0131nda; ya\u015f, y\u00fcksek akci\u011fer BT skorlar\u0131, serum ferritin, LDH ve CRP d\u00fczeylerinin \u015fiddetli klinik seyirle anlaml\u0131 d\u00fczeydeki ili\u015fkisi \u00e7al\u0131\u015fmam\u0131zda tespit edildi.\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e \u0130lk koronavirus hastal\u0131\u011f\u0131 2019 (COVID-19) olgusu \u00c7in\u2019in Vuhan kentinde te\u015fhis edilmi\u015ftir (1). COVID-19 olgular\u0131; asemptomatik seyir, pn\u00f6moni, akut solunum s\u0131k\u0131nt\u0131s\u0131 ve \u00e7oklu organ yetmezli\u011fi gibi farkl\u0131 klinik tablolar g\u00f6stermektedir (2). Benzer demografik \u00f6zelliklere sahip COVID-19 hastalar\u0131n\u0131n klinik seyrindeki farkl\u0131l\u0131klara bir\u00e7ok fakt\u00f6r\u00fcn sebep olabilece\u011fi g\u00f6sterilmi\u015ftir (3). COVID-19 baz\u0131 hastalarda \u00f6l\u00fcmc\u00fcl seyredebildi\u011finden, hekimlerin hastal\u0131\u011f\u0131n \u015fiddetini objektif […]<\/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":[5174,5536,5535],"class_list":["post-25827","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-covid-19","tag-klinik-siddet","tag-viral-yuk"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25827","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=25827"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25827\/revisions"}],"predecessor-version":[{"id":26219,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/25827\/revisions\/26219"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=25827"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=25827"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=25827"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}