Oğuzhan ÜSTÜN, Akif YARKAÇ, Seyran BOZKURT BABUŞ, Çağrı Safa BUYURGAN, Ataman KÖSE, Semra ERDOĞAN

65 yaş ve üstü Covid-19 hastalarında mortaliteye etki eden faktörlerin analizi

Amaç: Yaşlı hastalarda Covid-19’a bağlı ölüm oranlarının genç hastalara göre daha yüksek olduğu bildirilmiştir. Bu çalışma 65 yaş üstü hastalarda Covid-19’un klinik özelliklerini tanımlamayı ve mortaliteye etki eden faktörlerin değerlendirilmesini amaçlamaktadır. Yöntem: Bu çalışmaya XXX XXX Hastanesi Acil Servisi’ne 11.03.2020 ile 31.05.2021 tarihleri arasında başvuran 263 hasta dahil edildi. Covid-19 polimeraz zincir reaksiyon (PZR) testi pozitif olan hastaların yaş, cinsiyet, başvuru şikayeti, kullandığı ilaçlar, komorbid hastalıkları, laboratuvar elektronik bilgi yönetim sistemi üzerinden retrospektif olarak incelendi. Bu verilere göre ölen ve sağ kalan hastaların karşılaştırması yapıldı. Bulgular: Çalışmaya dahil edilen 263 hastada nefes darlığı, öksürük, balgam, bilinç değişikliği, genel durum bozukluğu şikayeti olanlarda ölüm oranının daha fazla olduğu görüldü. Ölen olguların ortalama parmak ucu satürasyon (SpO2)değerlerinin yaşayan olgulara göre daha düşük olduğu tespit edildi (p<0.001). Ölen olguların dakikada ortalama nabız sayılarının ve ortalama solunum sayılarının yaşayan olgulara göre daha yüksek olduğu tespit edildi (p<0.001). Sağ kalanlarda non steroid anti-inflamatuar ilaç ve antiagregan kullanımı daha fazla görüldü (p=0.046, p=0.027). Ölen olgularda antikoagülan kullanımının daha fazla olduğu tespit edildi (p=0.021). İnotrop, entübasyon, non invazif mekanik entilasyon ve steroidin ölen olgularda daha çok uygulandığı tespit edildi (p<0.001). Antiviral, antibiyotik, antikoagülan, tedavinin sağ kalan olgularda daha çok uygulandığı tespit edildi (p=0.026, p=0.002, p=0.009). Ölen olgularda pnömoni, böbrek yetmezliği, sepsis ve elektrolit bozukluğunun daha fazla olduğu gözlendi (p<0.001, p<0.001, p<0.001, p<0.001). SpO2 için ≤%86, nabız için >99/dk ve solunum sayısı >26/dk olan olgularda ölüm olabileceği gözlendi. SpO2 ve solunum sayısının mortaliteyi ayırıcı gücü yüksek iken (sırasıyla p<0.001, AUC=0.779; p<0.001, AUC=0.723) nabız için orta derecedeydi (p<0.001, AUC=0.659). Sonuç: Yaşlı hastalarda daha yüksek mortalite oranına sahip olan COVİD-19’da özellikle vital bulgular, kan gazı bulguları, acil serviste uygulanan tedaviler ve ek tanıları tanımlamak önemlidir. Çalışmamız bu açıdan yol gösterici olabilir.

Anahtar Kelimeler:

covid-19, mortalite, acil servis, yaşlı hasta

Analysis of factors affecting mortality in 65 years and older Covid-19 patients

Aim: It has been reported that mortality rates due to Covid-19 in elderly patients are higher than in younger patients. This study aimed to describe the clinical features of Covid-19 in patients over 65 years of age and to evaluate the factors affecting mortality. Method: 263 patients who applied to XXX XXX Hospital Emergency Department between 11.03.2020 and 31.05.2021 were included in this study. Age, gender, admission complaint, medications, comorbid diseases of patients with positive Covid-19 polymerase chain reaction (PCR) test were analyzed retrospectively through the laboratory electronic information management system. According to these data, the comparison of deceased and surviving patients was made. Results: The mortality rate was higher in those with complaints of dyspnea, cough, sputum, altered consciousness, and general condition disorder in 263 patients included in the study. It was determined that the mean fingertip saturation (SpO2) values of the deceased cases were lower than the surviving cases (p<0.001). It was determined that the mean heart rate per minute and mean respiratory rate of the deceased cases were higher than the surviving cases (p<0.001). Non steroidal anti-inflammatory drug and antiaggregant use was more common in survivors (p=0.046, p=0.027). It was determined that the use of anticoagulants was higher in deceased cases (p=0.021). It was determined that inotrope, intubation, non invasive mechanical ventilation and steroid were applied more frequently in deceased cases (p<0.001). It was determined that antiviral, antibiotic, anticoagulant treatment was applied more in survivors (p=0.026, p=0.002, p=0.009, respectively). Pneumonia, renal failure, sepsis, and electrolyte disturbances were observed to be more common in patients who died (p<0.001, p<0.001, p<0.001, p<0.001, respectively). It was observed that death could occur in cases with SpO2 ≤86%, pulse rate >99/min, and respiratory rate >26/min. While SpO2 and respiratory rate had a high discriminatory power for mortality (p<0.001, AUC=0.779; p<0.001, AUC=0.723, respectively), pulse rate had a moderate discriminatory power for mortality (p<0.001, AUC=0.659). Conclusion: It is important to define especially vital signs, blood gas findings, treatments applied in the emergency room and additional diagnoses in Covid-19, which has a higher mortality rate in elderly patients. Our study can be a guide in this respect.

Keywords:

Covid-19, mortality, emergency department, elderly patient,

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