COVID-19 sonrası poliklinik kontrolüne gelen hastaların klinik ve laboratuar özellikleri
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Date
2022
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Düzce Üniversitesi
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info:eu-repo/semantics/openAccess
Abstract
SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2), 2019 yılının Aralık ayında Hubei'de görülmeye başlayan, dünyaya hızla yayılan bir enfeksiyondur. DSÖ (Dünya Sağlık Örgütü) tarafından 2020 yılının Mart ayında pandemi olarak ilan edilmiştir. SARS-CoV-2 enfeksiyonu sonrası hastalarda klinik şikayetlerin devam ettiği dikkati çekmiştir. Çalışmamızda hastalığın uzun dönem etkilerini incelemek amaçlanmıştır. Çalışmaya 2020 yılı Kasım ayının başından 2021 yılının Ocak ayının sonu arasında kliniğimizde izlenen ters transkripsiyon polimeraz zincir reaksiyonu (RT-PCR) (+) ve RT-PCR (-) bilgisayarlı tomografide (BT) COVID-19 (Coronavirus Hastalığı-2019) pnömonisiyle uyumlu akciğer tutulumu olan 94 hasta dahil edildi. Hastaların sosyo-demografik özellikleri (yaşadıkları yer, medeni durum), yaş, cinsiyet, komorbiditeleri, aldıkları tedaviler, başvuru sırasında bakılan hemoglobin (Hb), D-dimer, ferritin, C-reaktif protein (CRP), alanin aminotransferaz (ALT), aspartat aminotransferaz (AST), laktat dehidrojenaz (LDH), parmak ucu saturasyon değerleri incelendi. Toraks BT' de akciğer tutulumları, pnömoninin ağırlık derecesi, kontrolde çekilen P-A (Posteror-anterior ) akciğer grafileri ve aldıkları anti-viral, antibiyotik, kortikosteroid, immünmodulatör, destek tedaviler değerlendirildi. Değerlendirmeler hastalar kontrole çağrıldıklarında da tekrarlandı. Hastaların başvuru ve kontrolleri arasındaki ortalama süre 38.2±30.2 gün idi. Çalışmamızda 59 erkek (orta yaş 61.5), 35 kadın (ort yaş 59.5) hasta yer aldı. Hastaların en sık gözlenen başvuru şikayetleri sırasıyla; nefes darlığı (%47.9), halsizlik (%47.9) , öksürük (%46.8), ateş yüksekliği (%29.8), kas ağrısı (%19.1) ve koku kaybıydı (%19.1). Hastaların %70 'i en sık hipertansiyon (HT), diyabet, ve kardiak iskemi gibi COVID-19 dışı ek hastalığa sahipti. COVID-19 dışı hastalığı bulunanların ortalama yaşları (64.4) bulunmayanlardan (51.2) anlamlı olarak fazlaydı (p=0.001). Hastaların %75'inden fazlasında tedavi yatarak gerçekleşirken, benzer orandaki hastalara oksijen tedavisi uygulanmıştı. Antikoagulan ve favipravir tedavileri %90'ın üstündeki oranlarda uygulanmıştı. Kortikosteroidler hastaların yaklaşık olarak %65'inde uygulanırken, anti IL-6 tedavisi %8.5 oranında uygulanmıştı. Hastaların %10.6'sına NIMV (servis veya yoğun bakım ünitesi) uygulanmış, %11.7'si ise yoğun bakım ünitesinde izlenmişti. Hastaların 1.ay kontrollerinde %60' ında radyolojik patoloji sürerken (erkeklerde kadınlarda daha sık radyolojik patoloji vardı), %35 inin üzerinde nefes darlığının olduğu (erkeklerde nefes darlığı kontrolde anlamlı düzeyde azalmamıştı), öksürük-halsizlik şikayetlerinin de %20' nin üzerinde devam ettiği tespit edildi. Sonuçta; COVID-19 aşısının henüz uygulanmaya başlanmadığı dönemde izlenen hasta grubunda yaklaşık 40 gün sonra yapılan kontrollerde dispnenin, öksürük ve halsizlik şikayetlerinin, radyolojik patolojinin sürdüğü gözlendi. Erkeklerde kontrolde dispnenin anlamlı düzeyde azalmaması, radyolojik patolojinin %60 üstünde sürmesi, enfeksiyonun erkeklerde daha ağır seyrettiğini bildiren literatürle uyumlu bulundu. Uzamış COVID-19 tablosu bulunan hastaların dikkatle izlenmeleri gerektiği vurgulandı.
SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) is an infection that started to appear in Hubei in December 2019 and spread rapidly around the world. It was declared a pandemic by WHO (World Health Organization) in March 2020. It was noted that clinical complaints continued in patients after SARS-coV2 infection. In our study, it was aimed to examine the long-term effects of the disease. The study included 94 patients with pulmonary involvement compatible with COVID-19 pneumonia in RT-PCR (+) and RT-PCR (-) with thorax CT followed up in our clinic between the beginning of November 2020 and the end of January 2021. Socio-demographic characteristics of the patients (where they live, marital status), age, gender, comorbidities, treatments, hemoglobin (Hb), D-dimer, ferritin, C-reactive protein (CRP), Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Lactate dehydrogenase (LDH), fingertip saturation values at admission were examined. Pulmonary involvement in thorax CT, severity of pneumonia, P-A (Posteror-anterior) chest radiographs taken in the control and anti-viral, antibiotic, corticosteroid, immunomodulatory and supportive treatments taken were evaluated. Evaluations were repeated when the patients were called for control. The mean time between patients' admission and controls was 38.2±30.2 days. Our study included 59 male (mean age 61.5 years), 35 female (mean age 59.5 years) patients. The most common complaints of the patients are respectively; dyspnea (47.9%), fatigue (47.9%), cough (46.8%), fever (29.8%), myalgia (19.1%), and loss of smell (19.1%). 70% of the patients had comorbidity other than COVID, most commonly HT, diabetes, and cardiac ischemia. The mean age of those with non-COVID disease (64.4) was significantly higher than that of those without (51.2) (p=0.001). While more than 75% of the patients received inpatient treatment, a similar proportion of patients received oxygen therapy. Anticoagulants and favipravir treatments were administered at rates above 90%. While corticosteroids were administered in approximately 65% of the patients, anti-IL-6 treatment was administered in 8.5% of the patients. NIMV (service or intensive care unit) was applied to 10.6% of the patients, and 11.7% were followed up in the intensive care unit. While radiological pathology persisted in 60% of the patients in the first month follow-ups (men had more frequent radiological pathologies in women), more than 35% had dyspnea (shortness of breath in men did not decrease significantly during control), cough-fatigue complaints continued in more than 20%. In conclusion; it was observed that dyspnea, cough and fatigue complaints, and radiological pathology continued in the controls performed approximately 40 days later in the patient group who were followed up in the period when the COVID vaccine was not yet started to be administered. The fact that dyspnea did not decrease significantly in the control group in men, and that the radiological pathology persisted above 60% was found to be consistent with the literature reporting that the infection was more severe in men. It was emphasized that patients with prolonged COVID-19 should be followed carefully.
SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) is an infection that started to appear in Hubei in December 2019 and spread rapidly around the world. It was declared a pandemic by WHO (World Health Organization) in March 2020. It was noted that clinical complaints continued in patients after SARS-coV2 infection. In our study, it was aimed to examine the long-term effects of the disease. The study included 94 patients with pulmonary involvement compatible with COVID-19 pneumonia in RT-PCR (+) and RT-PCR (-) with thorax CT followed up in our clinic between the beginning of November 2020 and the end of January 2021. Socio-demographic characteristics of the patients (where they live, marital status), age, gender, comorbidities, treatments, hemoglobin (Hb), D-dimer, ferritin, C-reactive protein (CRP), Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Lactate dehydrogenase (LDH), fingertip saturation values at admission were examined. Pulmonary involvement in thorax CT, severity of pneumonia, P-A (Posteror-anterior) chest radiographs taken in the control and anti-viral, antibiotic, corticosteroid, immunomodulatory and supportive treatments taken were evaluated. Evaluations were repeated when the patients were called for control. The mean time between patients' admission and controls was 38.2±30.2 days. Our study included 59 male (mean age 61.5 years), 35 female (mean age 59.5 years) patients. The most common complaints of the patients are respectively; dyspnea (47.9%), fatigue (47.9%), cough (46.8%), fever (29.8%), myalgia (19.1%), and loss of smell (19.1%). 70% of the patients had comorbidity other than COVID, most commonly HT, diabetes, and cardiac ischemia. The mean age of those with non-COVID disease (64.4) was significantly higher than that of those without (51.2) (p=0.001). While more than 75% of the patients received inpatient treatment, a similar proportion of patients received oxygen therapy. Anticoagulants and favipravir treatments were administered at rates above 90%. While corticosteroids were administered in approximately 65% of the patients, anti-IL-6 treatment was administered in 8.5% of the patients. NIMV (service or intensive care unit) was applied to 10.6% of the patients, and 11.7% were followed up in the intensive care unit. While radiological pathology persisted in 60% of the patients in the first month follow-ups (men had more frequent radiological pathologies in women), more than 35% had dyspnea (shortness of breath in men did not decrease significantly during control), cough-fatigue complaints continued in more than 20%. In conclusion; it was observed that dyspnea, cough and fatigue complaints, and radiological pathology continued in the controls performed approximately 40 days later in the patient group who were followed up in the period when the COVID vaccine was not yet started to be administered. The fact that dyspnea did not decrease significantly in the control group in men, and that the radiological pathology persisted above 60% was found to be consistent with the literature reporting that the infection was more severe in men. It was emphasized that patients with prolonged COVID-19 should be followed carefully.
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Keywords
Göğüs Hastalıkları, Chest Diseases, COVID 19, COVID 19
