PCO2, COVID-19 hastalarında mortalite belirteci olabilir mi?

Amaç: Corona Virüs Hastalığı 2019 (COVID-19) enfeksiyonunun klinik seyri, asemptomatikten düşük sağkalım oranlarına sahip orta ve şiddetli hastalığa kadar değişmektedir. Bu nedenle, COVID-19 mortalitesinin güvenilir bir şekilde tahmin edilmesi ve katkıda bulunan faktörlerin belirlenmesi, yüksek riskli bireyler için hedefe yönelik tedavilere olanak sağlayacaktır. Yoğun bakım ünitesinde (YBÜ) tedavi edilen COVID-19 hastalarında kısmi karbon dioksit (PCO2) konsantrasyonlarının mortaliteyi tahmin edip edemeyeceğini belirlemeyi amaçladık. Gereç ve Yöntem: Akut fizyoloji ve kronik sağlık değerlendirmesi (APACHE -2) skorları, ferritin, lenfosit sayısı, nötrofil lenfosit oranı (NLR), PCO2, kısmi oksijen konsantrasyonu/inspire edilen oksijen fraksiyon oranı (P/F) hasta dosyaları taranarak belirlendi ve hayatta kalanlarla ölen hastalar karşılaştırıldı. Bulgular: Ortalama APACHE-2 değeri ölen grupta sağ kalanlardan daha yüksekti. Ölen hastalar, sağ kalanlardan anlamlı olarak daha yaşlıydı (p=0,012). 7. günden itibaren, düşük bazal lenfosit sayıları mortalite için önemliydi (p=0,046). NLR, yoğun bakıma yatışta da yüksekti ve 7. günden itibaren mortalite açısından anlamlıydı (p=0,022). 10. günden itibaren, ölen grubunda PCO2 ve ferritin seviyeleri arttı. İlk 10 gün boyunca her iki grupta da tedavi ile P/F oranı arttı ve 13. günden sonra artış sağ kalanlarda devam ederken, ölen grubunda değerler azaldı. Sonuç: Bu çalışma, COVID-19 hastalarında PCO2 konsantrasyonundaki artışın, yüksek ferritin seviyesi, ileri yaş, yüksek APACHE skorları, düşük lenfosit sayısı, yüksek NLR ve yüksek P/F oranı ile birlikte mortaliteyi öngörebileceğini göstermiştir.

Anahtar Kelimeler:

COVID-19, PCO2, mortalite, pnömoni

Can PCO2 be a mortality predictor in COVID-19 patients?

Aim: The clinical course of Corona Virus Disease 2019 (COVID-19) infection is ranging from asymptomatic to moderate and severe disease with low survival rates. Therefore, reliable prediction of COVID-19 mortality and identification of contributing factors would allow targeted therapies for high-risk individuals. We aimed to determine whether partial carbon dioxide (PCO2) concentrations could predict mortality in patients treated in the intensive care unit (ICU). Material and Method: Acute Physiology and Chronic Health Evaluation (APACHE -2) scores, ferritin, lymphocyte count, neutrophil lymphocyte ratio (NLR), PCO2, partial oxygen concentration to inspired oxygen fraction (P/F) ratio were retrospectively determined and were compared between survivors and non-survivors. Results: The mean APACHE-2 value was higher in Group Non-survivors than in Group Survivors. Patients in Group Non-survivors were significantly older than those in Group Survivors (p=0,012). From day 7, low baseline lymphocyte counts were significant for mortality (p=0,046). NLR was also high at ICU admission, and it was significant for mortality from the 7th day (p=0.022). From day 10, PCO2 and ferritin levels increased in Group Non-survivors. The P/F ratio increased with treatment in both groups during the first 10 days, and after day 13, the increase continued in Group Survivors, whereas the values decreased in Group Non-survivors. We found that PCO2 concentrations in patients at ICU admission were as expected and that the increase in PCO2 could predict mortality along with increased ferritin levels, older age, high APACHE scores, low lymphocyte count, elevated NLR and high P/F ratio. Conclusion: This study showed that in patients with COVID -19, an increase in PCO2 concentration can predict mortality along with increased ferritin levels, older age, high APACHE scores, low lymphocyte count, elevated NLR and high P/F ratio.

Keywords:

COVID-19, mortality, pneumonia, PCO2,

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