Mustafa BOĞAN, İbrahim Feyyaz NALDEMİR, Hasan Baki ALTINSOY, İbrahim Ethem ŞAHİN, Mehmet KARADAĞ, Emel ÇALIŞKAN

Acil Pandemi Polikliniğine Başvuran ve COVID-19 Şüphesiyle Değerlendirilen Hastaların Retrospektif Analizi

Amaç: SARS-CoV-2 olarak adlandırılan yeni tip korona virüsün neden olduğu COVID-19 pandemisi halen tüm dünyada etkisini sürdürmektedir. COVID-19 etkeninin neden olduğu semptomlar diğer solunum yolu etkenlerine benzese de toplumsal etkileri oldukça şiddetli ve farklı seyretmektedir. Bu çalışma hastanemizin acil servis girişinde oluşturulan acil pandemi polikliniğine başvuran ve COVID-19 ön tanısıyla tetkik edilen hastaların analizinin yapılması amacıyla planlanmıştır.Gereç ve Yöntemler: Acil pandemi polikliniğine başvurmuş 16 yaş ve üzeri hastalardan, ateş, öksürük, nefes darlığı şikayetleri olup COVID-19 şüphesiyle polimeraz zincir reaksiyonu (PZR) testi için üst solunum yolundan sürüntü örneği alınmış ve Toraks bilgisayarlı tomografisi (TBT) yapılmış olanlar dahil edilmiştir. Bulgular: PZR testi pozitif ve negatif olan hastaların geliş şikayetleri karşılaştırıldığında, iki grubun da benzer şikayetlere sahip olduğu görülmüştür. PZR testi pozitif hastaların WBC sayıları (5748,39 ± 1547,01), nötrofil sayıları (3650,32 ± 1355,58), lenfosit sayıları (1467,74 ± 472,3) ve platelet sayıları (224,65 ± 76,01); PZR testi negatif olan hastalardan daha düşük bulunmuştur.Sonuç: COVID-19 PZR testi pozitif hastalarda daha düşük WBC, nötrofil ve lenfosit sayısı tespit edilmiştir. Toraks bilgisayarlı tomografi bulguları olan PZR pozitif vakalarda platelet sayısı daha düşük ve CRP değeri daha yüksek izlenmiştir. Bu verilerin özellikle ileri tanı testlerinin olmadığı veya geç sonuçlandığı sağlık kuruluşları için hastalıktan şüphelenme ve erken izolasyon için yol gösterici olabileceğini düşünmekteyiz.

Retrospective Analysis of Patients Admitted To The Emergency Pandemic Outpatient Clinic and Evaluated With Suspicion Of COVID-19

Aim: The COVID-19 pandemic caused by the new type of corona virus called SARS-CoV-2 is still effective all over the world. Although the symptoms caused by the COVID-19 agent are similar to other respiratory tract agents, their social effects are quite severe and different; we aimed to analyze the patients who applied to the emergency pandemic outpatient clinic created at the entrance of the emergency department in our hospital and who were examined with the pre-diagnosis of COVID-19. Material and Methods: Patients aged 16 and over who applied to the emergency pandemic outpatient clinic with complaints of fever, cough, and shortness of breath and those who received a swab sample from the upper respiratory tract for the polymerase chain reaction (PCR) test and had thorax computed tomography (TBT) were included. Results: When the complaints of the patients with positive and negative PCR tests were compared, it was seen that both groups had similar complaints. PCR positive patients WBC count (5748.39 ± 1547.01), neutrophil count (3650.32 ± 1355.58), lymphocyte count (1467.74 ± 472.3) and platelet count (224.65 ± 76.01); PCR was found lower than patients who were negative. Conclusion: Lower WBC, neutrophil and lymphocyte counts were detected in patients with positive COVID-19 PCR test. In PCR positive cases with TBT findings, the platelet count was lower and the CRP value was higher. We think that these data may be a guide for suspicion of disease and early isolation for healthcare institutions where there are no advanced diagnostic tests or late results.

PDF

___

1. Covid CDC, Team R. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)- United States, February 12-March 16, 2020. MMWR MorbMortalWklyRep. 2020; 69(12): 343-6.
2. Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. Jama. 2020; 323(14): 1406-7.
3. Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. In Statpearls [internet]. Treasure Island (FL): StatPearls Publishing; 2020 [Son güncelleme tarihi 20/10/2020; Erişim tarihi 15/06/2020]. Erişim Adresi: https://www.ncbi.nlm.nih.gov/books/NBK554776/.
4. Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated troponin in patients with Coronavirus Disease 2019 (COVID-19): possible mechanisms. J Card Fail. 2020; 26(6): 470-5.
5. Elsayed AM, Mohamed GA. Mean platelet volume and mean platelet volume/platelet count ratio as a risk stratification tool in the assessment of severity of acute ischemic stroke. Alexandria Journal of Medicine. 2017; 53(1): 67-70.
6. Thomas W, Varley J, Johnston A, Symington E, Robinson M, Sheares K, et al. Thrombotic complications of patients admitted to intensive care with COVID-19 at a teaching hospital in the United Kingdom. Thromb Res. 2020; 191: 76-7.
7. Wikipedia.org [İnternet]. San Diego: Wikimedia Foundation, Inc. [Son güncellenme tarihi 10/12/2020; Erişim tarihi: 12/06/2020]. Erişim adresi: https://tr.wikipedia.org/wiki/Türkiye%27de_COVID19_pandemisi.
8. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama. 2020; 323(11): 1061-9.
9. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020; 395(10223); 497-506.
10. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine. 2020; 382(18); 1708-20.
11. Li YX, Wu W, Yang T, Zhou W, Fu YM, Feng QM, et al. Characteristics of peripheral blood leukocyte differential counts in patients with COVID-19. Zhonghua Nei Ke Za Zhi. 2020; 59: E003.
12. Mardani R, Vasmehjani AA, Zali F, Gholami A, Nasab SDM, Kaghazian H, et al. Laboratory parameters in detection of COVID-19 patients with positive RT-PCR; a diagnostic accuracy study. Archives of Academic Emergency Medicine. 2020; 8(1): e43.
13. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clinica Chimica Acta. 2020; 506: 145-8.
14. Yang X, Yang Q, Wang Y, Wu Y, Xu J, Yu Y, et al. Thrombocytopenia and its association with mortality in patients with COVID‐19. Journal of Thrombosis and Haemostasis. 2020; 18(6): 1469-72.
15. Liu Y, Sun W, Guo Y, Chen L, Zhang L, Zhao S, et al. Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study. Platelets. 2020; 31(4): 490-6.
16.Cheng Z, Lu Y, Cao Q, Qin L, Pan Z, Yan F, et al. Clinical features and chest CT manifestations of coronavirus disease 2019 (COVID-19) in a singlecenter study in Shanghai, China. American Journal of Roentgenology. 2020; 215(1): 121-6.
17. Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W, et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. New England Journal of Medicine. 2020; 382(17): e38.
18. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020; 296(2): E32- E40.
19. Yoon SH, Lee KH, Kim JY, Lee YK, Ko H, Kim KH, et al. Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): analysis of nine patients treated in Korea. Korean Journal of Radiology. 2020; 21(4): 494-500.
20.Caruso D, Zerunian M, Polici M, Pucciarelli F, Polidori T, Rucci C, et al. Chest CT features of COVID-19 in Rome, Italy. Radiology. 2020; 296(2): E79-E85.
21.Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationshiptoduration of infection. Radiology. 2020; 295(3): 200463.
22. Long C, Xu H, Shen Q, Zhang X, Fan B, Wang C, et al. Diagnosis of the Coronavirus disease (COVID-19): rRT-PCR or CT? European Journal of Radiology. 2020; 126: 108961.