{"id":27337,"date":"2023-09-30T00:18:08","date_gmt":"2023-09-29T21:18:08","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=27337"},"modified":"2023-09-30T00:33:16","modified_gmt":"2023-09-29T21:33:16","slug":"covid-19da-morbidite-ve-mortalite","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2023\/09\/30\/covid-19da-morbidite-ve-mortalite\/","title":{"rendered":"Ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 Bask\u0131lanm\u0131\u015f Hastalarda COVID-19 \u0130nfeksiyonuna Ba\u011fl\u0131 Morbidite ve Mortalite: Hangi Fakt\u00f6rler Etkili?"},"content":{"rendered":"

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

\u015eiddetli akut solunum yolu sendromu virusu (SARS-CoV-2) koronavirus hastal\u0131\u011f\u0131 (COVID-19) pandemisine yol a\u00e7m\u0131\u015ft\u0131r. Bu pandemi k\u00fcresel \u00f6l\u00e7ekte t\u00fcm sa\u011fl\u0131k sistemleri i\u00e7in tehdit haline gelmi\u015ftir. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) 10 A\u011fustos 2023 tarihi itibari ile pandeminin d\u00fcnya \u00e7ap\u0131nda 750 milyondan fazla olgu ve yakla\u015f\u0131k 7 milyon \u00f6l\u00fcme neden oldu\u011funu bildirmi\u015ftir (1). COVID-19, \u00f6ncelikle ate\u015f ve alt solunum yolu semptomlar\u0131 ile karakterizedir; ancak \u015fiddeti asemptomatik hastal\u0131ktan akut solunum s\u0131k\u0131nt\u0131s\u0131 sendromuna (ARDS), septik \u015foka, \u00e7oklu organ yetmezli\u011fine ve \u00f6l\u00fcme yol a\u00e7an farkl\u0131 sonu\u00e7lara da neden olabilmektedir. Klinik olarak, COVID-19 infeksiyonu olan hastalar\u0131n b\u00fcy\u00fck bir b\u00f6l\u00fcm\u00fc hafif veya orta derecede grip benzeri semptomlar g\u00f6sterir; yaln\u0131zca %5\u2019i ciddi ve kritik semptomlar sonucu hastane veya yo\u011fun bak\u0131m \u00fcnitesi (YB\u00dc)\u2019nde yat\u0131r\u0131larak izlenir. Hastaneye yat\u0131\u015f ve \u00f6l\u00fcm\u00fcn en g\u00fc\u00e7l\u00fc belirleyicisi ya\u015f (>65) iken komorbiditesi olan hastalar ya\u015ftan ba\u011f\u0131ms\u0131z olarak ciddi hastal\u0131k riski alt\u0131ndad\u0131r (2-5).<\/p>\n

Sa\u011fl\u0131kl\u0131 bireylere k\u0131yasla daha \u015fiddetli komplikasyonlara e\u011filimli olan ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalar aras\u0131nda COVID-19\u2019un temel \u00f6zellikleri ve sonu\u00e7lar\u0131 iyi karakterize edilmemi\u015ftir. Ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalardaki viral infeksiyonlar\u0131n ciddi hastal\u0131\u011fa ilerleme olas\u0131l\u0131\u011f\u0131 daha y\u00fcksektir; kanser veya transplantasyon ciddi COVID-19 geli\u015fimi i\u00e7in bir risk fakt\u00f6r\u00fc olarak kabul edilmektedir (6-8). Bununla birlikte, Gisondi ve arkada\u015flar\u0131 (9) imm\u00fcnos\u00fcpresif tedavi al\u0131p almad\u0131klar\u0131na bak\u0131lmaks\u0131z\u0131n COVID-19 hastalar\u0131 aras\u0131nda benzer sonu\u00e7lar bildirmi\u015ftir. COVID-19 tan\u0131l\u0131 hastalar\u0131n irdelendi\u011fi bir meta-analizde, ciddi COVID-19 ile ili\u015fkili sonu\u00e7lar\u0131n 65 ya\u015f \u00fcst\u00fc olunmas\u0131 ve komorbiditeler (hipertansiyon ve diyabet dahil) ile ili\u015fkili oldu\u011fu ancak kanser ile ili\u015fkili olmad\u0131\u011f\u0131n\u0131 bildirilmi\u015ftir (10). Ayr\u0131ca, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalar daha ya\u015fl\u0131 olup ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanmam\u0131\u015f hastalara g\u00f6re daha fazla altta yatan hastal\u0131\u011fa sahiptir; bununla birlikte imm\u00fcns\u00fcpresif durumun daha \u015fiddetli SARS-CoV-2 infeksiyonu ve\/veya mortalite ile ili\u015fkili olup olmad\u0131\u011f\u0131na dair veriler yetersizdir (11). Risk fakt\u00f6rlerinin veya predispozan fakt\u00f6rlerin belirlenmesi, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalarda COVID-19 gibi hayat\u0131 tehdit eden infeksiyonun y\u00f6netiminde kritik rol oynamaktad\u0131r (12). \u0130nfeksiyonun erken d\u00f6neminde ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131t\u0131n\u0131n engellenmesi potansiyel olarak kontrols\u00fcz viral replikasyona ve \u015fiddetli hastal\u0131\u011fa ortam sa\u011flayabilir (13). Do\u011frulanm\u0131\u015f COVID-19 olgular\u0131 ve buna ba\u011fl\u0131 \u00f6l\u00fcmler g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda; ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalar, mortalite \u00fczerine etki eden risk fakt\u00f6rleri ve zemin haz\u0131rlayan terap\u00f6tik ajanlar\u0131n belirlenmesi, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalarda COVID-19 gibi hayat\u0131 tehdit eden infeksiyonun y\u00f6netiminde \u00e7ok \u00f6nemlidir. Bu \u00e7al\u0131\u015fmada, kanserli hastalar (solid\/hematolojik) ve organ nakli al\u0131c\u0131lar\u0131 da dahil olmak \u00fczere \u00e7e\u015fitli ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalarda COVID-19\u2019un temel y\u00f6nlerini ve sonu\u00e7lar\u0131n\u0131 ara\u015ft\u0131rmay\u0131 ama\u00e7lad\u0131k. <\/span><\/p>\n

Y\u00d6NTEMLER<\/h2>\n

Retrospektif, tek merkezli ve kesitsel olan bu \u00e7al\u0131\u015fmaya, Mart 2020-Nisan 2022 tarihleri aras\u0131nda \u0130stanbul \u00dcniversitesi-Cerrahpa\u015fa, Cerrahpa\u015fa T\u0131p Fak\u00fcltesi Hastanesi\u2019ne ba\u015fvuran ve polimeraz zincir reaksiyonu (PZR<\/span>) testi ile COVID-19 tan\u0131s\u0131 alm\u0131\u015f, kanserli (solid organ\/hematolojik), romatizmal hastal\u0131\u011f\u0131 olan veya organ nakli yap\u0131lm\u0131\u015f 18 ya\u015f\u0131ndan b\u00fcy\u00fck hastalar dahil edildi. E\u015flik eden COVID-19 ve imm\u00fcnos\u00fcpresyon durumu olmayan hastalar \u00e7al\u0131\u015fmaya dahil edilmedi.<\/p>\n

\u00c7al\u0131\u015fma kapsam\u0131nda; hastanemizde yatarak izlenen t\u00fcm COVID-19 hastalar\u0131 i\u00e7in standart olarak kaydedilmi\u015f veri setlerinde yer alan demografik bilgiler, laboratuvar bulgular\u0131, tedaviler ve sonu\u00e7lar\u0131 irdelendi. L\u00f6kosit say\u0131s\u0131 (WBC), lenfosit say\u0131s\u0131 (Ly), trombosit say\u0131s\u0131 (Plt), \u00fcre, kreatinin, alanin aminotransferaz (ALT), aspartat aminotransferaz (AST), laktat dehidrogenaz (LDH), C-reaktif protein (CRP), ferritin, D-dimer ve fibrinojen d\u00fczeyleri hastaneye ilk kabul s\u0131ras\u0131nda ve d\u00fczenli aral\u0131klarla kontrol edilmi\u015fti. G\u00fcncellenen rehberler ve T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 \u00f6nerileri do\u011frultusunda hastalara hidroksiklorokin, azitromisin, oseltamivir, lopinavir\/ritonavir ve favipiravir tedavileri uygulanm\u0131\u015ft\u0131. Solunum s\u0131k\u0131nt\u0131s\u0131 nedeniyle oksijen tedavisi deste\u011fi ihtiyac\u0131 olan hastalarda 6 mg\/g\u00fcn deksametazon veya 0.5-1 mg\/kg prednisolon veya e\u015fde\u011feri metilprednisolon uygulan\u0131rken antikoag\u00fclan profilaksi olarak hastaneye yat\u0131r\u0131lan t\u00fcm hastalara aktif kanama veya trombositopeni <25-30 000\/\u00b5l) olmad\u0131\u011f\u0131 s\u00fcrece tromboz profilaksisi olarak d\u00fc\u015f\u00fck molek\u00fcler a\u011f\u0131rl\u0131kl\u0131 heparin (0.4 ml \u00e7\u00f6zelti i\u00e7eren kullan\u0131ma haz\u0131r enjekt\u00f6rde 4000 anti-Xa \u0130\u00dc\u2019ye e\u015fde\u011fer 40 mg) verilmi\u015fti.<\/p>\n

\u00c7al\u0131\u015fma, \u0130stanbul \u00dcniversitesi- Cerrahpa\u015fa T\u0131p Fak\u00fcltesi Klinik Ara\u015ft\u0131rmalar Etik Kurulu taraf\u0131ndan 06 Nisan 2023 tarihinde 660490 karar numaras\u0131yla onaylanm\u0131\u015ft\u0131r. Hastalar\u0131n verileri geriye d\u00f6n\u00fck olarak incelendi\u011fi i\u00e7in bilgilendirilmi\u015f yaz\u0131l\u0131 onam formu al\u0131nmad\u0131.<\/p>\n

\u0130statistiksel Analiz<\/h3>\n

\u0130statistik analizler, R yaz\u0131l\u0131m\u0131 versiyon 4.2.0 (R Foundation, Avusturya; <\/span>https:\/\/www.r-project.org\/<\/span>) ile yap\u0131ld\u0131. Genel istatistik analizlerinde gtsummary versiyon 1.6.0, rstatix versiyon 0.7.0, survival versiyon 3.3.1 ve ggsurvfit versiyon 0.3.0 paketlerinden yararlan\u0131ld\u0131 (14-17). De\u011fi\u015fkenlerin normal da\u011f\u0131l\u0131ma uygunlu\u011fu Shapiro-Wilk testi ile Q-Q plot ve histogram grafikleri ile denetlendi. S\u00fcrekli de\u011fi\u015fkenler ortanca (min.-mak. veya 25.-75. \u00e7eyrek) ve ortalama\u00b1standart sapma olarak belirtildi. Kategorik de\u011fi\u015fkenler frekans (y\u00fczde) ile g\u00f6sterildi. S\u00fcrekli veriler, veriler normal da\u011f\u0131ld\u0131\u011f\u0131nda ve iki grup oldu\u011funda ba\u011f\u0131ms\u0131z gruplar t testi; normal da\u011f\u0131lmad\u0131\u011f\u0131nda ve iki grup oldu\u011funda Wilcoxon s\u0131ra toplam\u0131 (\u201crank-sum\u201d) testi ile analiz edildi. Kategorik veriler g\u00f6zlem say\u0131lar\u0131 yeterli oldu\u011funda Pearson \u03c72<\/sup> testi ile yetersiz oldu\u011funda Fisher kesin testi ile de\u011ferlendirildi. Yirmi sekiz g\u00fcnl\u00fck takip s\u00fcresi i\u00e7erisinde sa\u011fkal\u0131m oranlar\u0131n\u0131n kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131 i\u00e7in log kar\u015f\u0131la\u015ft\u0131rmal\u0131 Kaplan-Meier analizi yap\u0131ld\u0131; sa\u011fkal\u0131ma etki eden fakt\u00f6rlerin belirlenmesi i\u00e7in Cox regresyon analizi yap\u0131lm\u0131\u015f olup \u201chazard\u201d oranlar\u0131 (HR) ve g\u00fcven aral\u0131klar\u0131 (GA) hesapland\u0131. Tek de\u011fi\u015fkenli analizde p<\/i> de\u011feri <0.05 alt\u0131nda olan de\u011fi\u015fkenler ile \u00e7ok de\u011fi\u015fkenli Cox regresyon modeli olu\u015fturuldu ve p<\/i><0.05 de\u011ferleri anlaml\u0131 d\u00fczey olarak kabul edildi.<\/span><\/p>\n

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

Tablo 1.<\/strong> Hastalar\u0131n 28 G\u00fcnl\u00fck Klinik Sonlan\u0131mlar\u0131na G\u00f6re Demografik ve Klinik \u00d6zellikleri<\/p><\/div>\n

\"\"<\/a>

Tablo 2.<\/strong> Hastalar\u0131n 28 G\u00fcnl\u00fck Klinik Sonlan\u0131mlar\u0131na G\u00f6re Demografik ve Klinik \u00d6zellikleri<\/p><\/div>\n

\"\"<\/a>

Tablo 3.<\/strong> Hastalar\u0131n 28 G\u00fcnl\u00fck Klinik Sonlan\u0131mlar\u0131na G\u00f6re Oksijen Sat\u00fcrasyonu ve Kan Parametrelerinin K\u0131yaslanmas\u0131<\/p><\/div>\n

\u00c7al\u0131\u015fmaya COVID-19 tan\u0131s\u0131 alan ve ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f 340 eri\u015fkin hasta dahil edildi. Hastalar\u0131n 172 (%51)\u2019si kad\u0131nd\u0131 ve ya\u015f ortalamas\u0131 61\u00b115 y\u0131l idi. Toplamda 122 hasta hayat\u0131n\u0131 kaybetmi\u015f olup hastane i\u00e7i \u00f6l\u00fcm oran\u0131 %35.8 olarak tespit edildi. Yo\u011fun bak\u0131m \u00fcnitesine yat\u0131r\u0131lan hastalar\u0131n \u00f6l\u00fcm oran\u0131 (%73.4) di\u011fer servislere yat\u0131r\u0131lan hastalara g\u00f6re daha y\u00fcksekti. \u0130ki y\u00fcz otuz alt\u0131 (%69) hastada malignite mevcut olup 172 hasta ile solid organ kanseri en y\u00fcksek orandaki hasta grubunu olu\u015fturuyordu. Altta yatan hastal\u0131k olarak en s\u0131k hipertansiyon (n=113) ve diabetes mellitus (n=64) saptand\u0131. Toraks tomografisi \u00e7ekilen hastalar\u0131n 295 (%87)\u2019inde tipik tutulum paterni izlendi. Tedavi olarak 260 (%77) hastaya favipiravir kullan\u0131lm\u0131\u015ft\u0131. Hastalar\u0131n 300 (%88)\u2019\u00fc antikoag\u00fclan tedavi alm\u0131\u015ft\u0131 ve imm\u00fcnmodulat\u00f6r tedavi olarak en s\u0131k kortikosteroid 194 (%57) ve tosilizumab 55 (%16) uygulanm\u0131\u015ft\u0131. Hastanede yat\u0131\u015f s\u00fcrecinde hastalar\u0131n 158 (%46)\u2019i YB\u00dc\u2019de izlenmi\u015fti (Tablo1).<\/p>\n

Laboratuvar parametreleri incelendi\u011finde; 28 g\u00fcnl\u00fck takipte hayat\u0131n\u0131 kaybeden hastalar\u0131n en y\u00fcksek laboratuvar medyan de\u011ferlerinden \u00fcre (mg\/dl), LDH (mg\/dl), D-dimer, ferritin (ml\/ng), CRP (mg\/lt) de\u011ferleri hayatta kalan hastalar\u0131n de\u011ferlerine g\u00f6re anlaml\u0131 derecede y\u00fcksek bulundu (p<\/i><0.001). Hayat\u0131n\u0131 kaybeden hastalar\u0131n ilk \u00f6l\u00e7\u00fcmde lenfosit (103\/\u00dcl) medyan de\u011feri hayatta kalan hasta grubu ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda anlaml\u0131 d\u00fczeyde d\u00fc\u015f\u00fck tespit edildi (p<\/i><0.001) (Tablo 2).<\/p>\n

Yo\u011fun bak\u0131m \u00fcnitesine yat\u0131r\u0131lan hastalardaki \u00f6l\u00fcm oran\u0131 (%73.4) di\u011fer servislerde izlenen hastalara g\u00f6re daha y\u00fcksek tespit edildi. Tek de\u011fi\u015fkenli analizdeki istatistiksel a\u00e7\u0131dan anlaml\u0131 (p<\/i><0.05) de\u011fi\u015fkenler \u00e7ok de\u011fi\u015fkenli analize dahil edildi. \u00c7ok de\u011fi\u015fkenli analiz sonucuna g\u00f6re YB\u00dc\u2019ye yat\u0131\u015f ile mortalite aras\u0131nda anlaml\u0131 bir ili\u015fki mevcut olup YB\u00dc\u2019ye yatm\u0131\u015f olmak mortaliteyi 13.6 (HR=13.6, %95 GA=5.66-32.9; p<\/i><0.001) kat art\u0131rmaktayd\u0131. Yine \u00e7ok de\u011fi\u015fkenli analiz de\u011ferlendirmesinin sonucunda, antikoag\u00fclan tedavi (HR=0.50, %95 GA=0.27-0.93; p<\/i>=0.029) <\/b>ve nazal kan\u00fcl ile oksijen deste\u011finin (HR=0.40, %95 GA=0.25-0.63; p<\/i><0.001) mortaliteyi anlaml\u0131 d\u00fczeyde azaltt\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc (Tablo 3).<\/p>\n

\"\"<\/a>

\u015eekil 1a.<\/strong> COVID-19 Tan\u0131s\u0131yla Hastaneye Yat\u0131\u015f\u0131 Yap\u0131lan Malignite Tan\u0131l\u0131 Hastalar\u0131n Sa\u011fkal\u0131m Analiz E\u011frisi<\/p><\/div>\n

\"\"<\/a>

\u015eekil 1b.<\/strong> COVID-19 Tan\u0131s\u0131yla Hastaneye Yat\u0131\u015f\u0131 Yap\u0131lan Solig Organ\/Hematolojik Malignite Tan\u0131l\u0131 Hastalar\u0131n Sa\u011fkal\u0131m Analiz E\u011frisi<\/p><\/div>\n

Solid\/hematolojik olarak kanser tan\u0131s\u0131 alm\u0131\u015f hastalar ve t\u00fcm imm\u00fcnos\u00fcpresif durumlar kendi aralar\u0131nda kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda mortalite a\u00e7\u0131s\u0131ndan anlaml\u0131 bir fark saptanmad\u0131 (\u015eekil 1a, b).<\/p>\n

Tek de\u011fi\u015fkenli analiz sonucunda olu\u015fturulan \u00e7oklu Cox regresyon modeline g\u00f6re, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalarda nihai COVID-19 sonucu ile ilgili olarak YB\u00dc\u2019ye yatm\u0131\u015f olmak mortaliteyi art\u0131ran en \u00f6nemli durum olarak saptand\u0131.<\/p>\n

\u0130RDELEME<\/h2>\n

Ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalar COVID-19\u2019un ciddi komplikasyonlar\u0131 a\u00e7\u0131s\u0131ndan risk alt\u0131nda olup \u00e7al\u0131\u015fmam\u0131zda ba\u011f\u0131\u015f\u0131kl\u0131k sistemi bask\u0131lanm\u0131\u015f COVID-19 tan\u0131l\u0131 hastalarda bu durumun olumsuz sonu\u00e7larla ili\u015fkili olup olmad\u0131\u011f\u0131 de\u011ferlendirildi.<\/p>\n

\u0130lk olarak \u00c7in\u2019den ve sonras\u0131nda d\u00fcnyan\u0131n farkl\u0131 yerlerinden yay\u0131mlanan \u00e7al\u0131\u015fmalarda, COVID-19\u2019un sonu\u00e7lar\u0131n\u0131n ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f yeti\u015fkin hastalarda daha k\u00f6t\u00fc sonu\u00e7lar yaratt\u0131\u011f\u0131 bildirilmi\u015ftir (6,12,13,18). \u00c7al\u0131\u015fmam\u0131zda imm\u00fcnos\u00fcprese hastalar\u0131n mortalitesi 122\/340 (%35.8) olarak bulunmu\u015f olup bu oran merkezimizde ayn\u0131 veri taban\u0131ndan genel pop\u00fclasyon kay\u0131tlar\u0131n\u0131n verileri kullan\u0131larak yap\u0131lan ba\u015fka bir \u00e7al\u0131\u015fmadaki mortalite oran\u0131 (%11) ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda daha y\u00fcksek oldu\u011fu belirlenmi\u015ftir (22). Benzer \u015fekilde \u00fclkemizde yap\u0131lan bir \u00e7al\u0131\u015fmada, hematolojik malignite tan\u0131l\u0131 ayaktan ve yatarak izlenen hastalarda COVID-19 ge\u00e7iren grupta mortalite (%22.8) y\u00fcksek bulunmu\u015ftur (23). Di\u011fer yanda baz\u0131 veriler, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalar\u0131n, genel pop\u00fclasyona benzer \u015fekilde hastal\u0131\u011f\u0131 ge\u00e7irdi\u011fini g\u00f6stermektedir (9, 24-27). Bu \u00e7eli\u015fkili bulgular; imm\u00fcn bask\u0131laman\u0131n farkl\u0131 tan\u0131mlar\u0131yla, kanser t\u00fcr\u00fc ve a\u015famas\u0131yla (28), transplantasyon t\u00fcr\u00fc ve d\u00f6nemiyle (29), altta yatan hastal\u0131klarla, kullan\u0131lan imm\u00fcnos\u00fcpresif tedavilerin farkl\u0131 olmas\u0131yla, tedavi ayr\u0131nt\u0131lar\u0131n\u0131n standart olmamas\u0131yla ve \u00e7al\u0131\u015fmalar\u0131n az say\u0131da imm\u00fcn sistemi bask\u0131lanm\u0131\u015f hastay\u0131 i\u00e7ermesi ile a\u00e7\u0131klanabilir.<\/p>\n

Altta yatan hastal\u0131k olarak \u00e7al\u0131\u015fmam\u0131zda en s\u0131k hipertansiyon ve diabetes mellitus saptand\u0131. Bu veriler d\u00fcnyan\u0131n de\u011fi\u015fik b\u00f6lgelerinden bildirilen \u00e7al\u0131\u015fmalarla uyumluydu (5,10,12,13,30,31). Erkek cinsiyette mortaliteyle daha s\u0131k kar\u015f\u0131la\u015f\u0131ld\u0131\u011f\u0131 bildirilmekle birlikte \u00e7al\u0131\u015fmam\u0131zda \u00f6l\u00fcm oran\u0131 ile cinsiyet aras\u0131nda anlaml\u0131 bir ili\u015fki bulamad\u0131k (32).<\/p>\n

Literat\u00fcr irdelendi\u011finde, ciddi klinik seyir g\u00f6steren hastalarda baz\u0131 laboratuvar sonu\u00e7lar\u0131nda anormallik g\u00f6zlenmekte olup bu nedenle laboratuvar biyobelirte\u00e7lerinden baz\u0131lar\u0131n\u0131n hastal\u0131k sonucunu tahmin etmek i\u00e7in kullan\u0131labilece\u011fi \u00f6ng\u00f6r\u00fclmektedir.\u00a0 <\/span>Yap\u0131lan \u00e7al\u0131\u015fmalarda, genel olarak ciddi hastal\u0131k ve \u00f6l\u00fcm oran\u0131 ile laboratuvar biyobelirte\u00e7 anormallikleri aras\u0131ndaki ili\u015fki analiz edilmi\u015ftir; CRP, LDH, D-dimer, \u00fcre, kreatinin, kardiyak troponin I, ALT, AST, l\u00f6kosit ve PT y\u00fcksekli\u011fi, lenfosit ve trombosit d\u00fc\u015f\u00fckl\u00fc\u011f\u00fc ile daha k\u00f6t\u00fc sonu\u00e7 ve \u00f6l\u00fcm aras\u0131nda ili\u015fki oldu\u011fu bildirilmi\u015ftir (30,33-37). \u00c7al\u0131\u015fmam\u0131zda da bu verilerle uyumlu olarak, 28 g\u00fcnl\u00fck takipte hayat\u0131n\u0131 kaybeden hastalar\u0131n en y\u00fcksek laboratuvar medyan de\u011ferlerinden \u00fcre, LDH, D-dimer,<\/span> ferritin, CRP de\u011ferleri hayatta kalan hastalar\u0131n de\u011ferlerine g\u00f6re anlaml\u0131 derecede y\u00fcksek, ilk \u00f6l\u00e7\u00fcm lenfosit medyan de\u011feri ise hayatta kalan hasta grubu ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda anlaml\u0131 d\u00fczeyde d\u00fc\u015f\u00fck olarak bulundu.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, YB\u00dc\u2019ye yat\u0131r\u0131lan hastalardaki \u00f6l\u00fcm oran\u0131 (%73.4) serviste yatan hastalara g\u00f6re anlaml\u0131 d\u00fczeyde daha y\u00fcksek bulundu. \u00c7ok de\u011fi\u015fkenli analiz sonucuna g\u00f6re YB\u00dc\u2019ye yatm\u0131\u015f olmak mortaliteyi 13.6 kat art\u0131rmakta olup bu bulgu di\u011fer \u00e7al\u0131\u015fmalar ile de uyumluydu (12,13,31). Yine \u00e7ok de\u011fi\u015fkenli analiz de\u011ferlendirme sonucuna g\u00f6re antikoag\u00fclan tedavinin <\/b>ve nazal kan\u00fcl ile oksijen deste\u011fi sa\u011flanmas\u0131n\u0131n mortaliteyi azaltt\u0131\u011f\u0131n\u0131 tespit ettik. Bu bulgu, hastal\u0131k ile ilgili ilk verilerin elde edilmesi sonras\u0131 antikoag\u00fclan tedavinin ve ciddi akci\u011fer tutulumu olan hastalarda erken oksijen deste\u011finin rehberlerin ortak \u00f6nerisi haline gelmesi sonucunu desteklemektedir. Di\u011fer tedaviler, \u00e7al\u0131\u015fmalar\u0131n zaman\u0131na, merkeze ve \u00fclkeye g\u00f6re \u00f6nemli \u00f6l\u00e7\u00fcde de\u011fi\u015fiklik g\u00f6stermektedir (13).<\/p>\n

Hastalar\u0131n kanser evre verilerinin yan\u0131 s\u0131ra ayr\u0131nt\u0131l\u0131 imm\u00fcnos\u00fcpresif tedavi bilgilerinin ve tedavi zamanlar\u0131n\u0131n olmamas\u0131 \u00e7al\u0131\u015fmam\u0131z\u0131n \u00f6nemli bir k\u0131s\u0131tl\u0131l\u0131\u011f\u0131d\u0131r. Ayr\u0131ca hastal\u0131k aktivitesinin akut veya kronik olarak kabul edilip edilmedi\u011fini ve malignitelerin stabil hastal\u0131k, hastal\u0131k progresyonu veya uzak metastaz i\u00e7erip i\u00e7ermedi\u011fini belirleyemedik. Organ nakil hastalar\u0131nda terap\u00f6tik ajan\u0131n veya nakil tipinin sonu\u00e7 \u00fczerindeki etkisi gibi alt k\u00fcme analizleri de yap\u0131lamad\u0131. \u00c7al\u0131\u015fmam\u0131z\u0131n retrospektif olmas\u0131 nedeniyle a\u015f\u0131 verilerinin olmamas\u0131 da bir di\u011fer \u00f6nemli k\u0131s\u0131tl\u0131l\u0131k olarak kar\u015f\u0131m\u0131za \u00e7\u0131kt\u0131.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalar\u0131n genel pop\u00fclasyona k\u0131yasla COVID-19 nedeniyle hastaneye yatmas\u0131 gereken hastalar aras\u0131nda daha k\u00f6t\u00fc sonu\u00e7lara sahip oldu\u011funu ve baz\u0131 belirte\u00e7lerin olumsuz sonu\u00e7lar i\u00e7in \u00f6n g\u00f6rd\u00fcr\u00fcc\u00fc olabilece\u011fini ortaya koyduk. Ayr\u0131ca, YB\u00dc\u2019ye yatm\u0131\u015f olmak mortaliteyi art\u0131ran en \u00f6nemli durum olarak saptand\u0131. Sonu\u00e7 olarak; bu verilerden kesin ve kal\u0131c\u0131 sonu\u00e7lar \u00e7\u0131karmak zordur. Elde edilecek yeni bilgiler ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131lanm\u0131\u015f hastalar\u0131 hem daha iyi y\u00f6netmemize hem de daha iyi tedavi etmemize olanak sa\u011flayacakt\u0131r. Farkl\u0131 imm\u00fcn yetmezlik t\u00fcrlerinin COVID-19 hastal\u0131\u011f\u0131n\u0131n daha iyi y\u00f6netilmesinde oynayabilece\u011fi rol\u00fc g\u00f6sterebilmek ve ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131layan durumlar\u0131n ve tedavilerin COVID-19 hastal\u0131\u011f\u0131n\u0131n prognozu \u00fczerindeki olas\u0131 riskini belirleyebilmek i\u00e7in geni\u015f \u00f6rneklem i\u00e7eren prospektif kontroll\u00fc \u00e7al\u0131\u015fmalara ihtiya\u00e7 oldu\u011funu d\u00fc\u015f\u00fcnmekteyiz.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e \u015eiddetli akut solunum yolu sendromu virusu (SARS-CoV-2) koronavirus hastal\u0131\u011f\u0131 (COVID-19) pandemisine yol a\u00e7m\u0131\u015ft\u0131r. Bu pandemi k\u00fcresel \u00f6l\u00e7ekte t\u00fcm sa\u011fl\u0131k sistemleri i\u00e7in tehdit haline gelmi\u015ftir. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) 10 A\u011fustos 2023 tarihi itibari ile pandeminin d\u00fcnya \u00e7ap\u0131nda 750 milyondan fazla olgu ve yakla\u015f\u0131k 7 milyon \u00f6l\u00fcme neden oldu\u011funu bildirmi\u015ftir (1). COVID-19, \u00f6ncelikle ate\u015f ve […]<\/p>\n","protected":false},"author":4,"featured_media":27689,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5792,5174,2997],"class_list":["post-27337","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-bagisiklik-sistemi-baskilanmis","tag-covid-19","tag-mortalite"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27337","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=27337"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27337\/revisions"}],"predecessor-version":[{"id":27628,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27337\/revisions\/27628"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/27689"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=27337"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=27337"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=27337"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}