Hayri CANBAZ, Attila BEŞTEMİR, Aziz ahmet SUREL, Bülent AYDINLI, Erdal YEKELER, Uluğ ELDEGEZ, Serap AYKUT AKA

TÜRKİYE‘DE COVID-19 İLE ENFEKTE OLAN SOLİD ORGAN NAKİLLİ HASTALARIN ACİL SERVİS VE HASTANE BAŞVURULARININ İNCELENMESİ

Giriş: COVID-19 pandemisinde hastalık, insandan insana bulaşma özelliği nedeniyle aile ve toplum yaşamını olumsuz etkilemiş, hızla yayılarak Acil Servis başvurularında aşırı bir artış oluşturmuştur. Transplantasyon yapılan hastalar gibi hassas hastaların bakımı da zor bir hal almıştır. Hem aile içindeki bulaş hem de toplum içindeki bulaş nedeniyle Acil Servislerde bu hassas hastaların bakımı, değerlendirilmesi, acil tanısı ve yatış kararı kritik öneme haizdir. Bu çalışmada amacımız; Acil servis başvurularının arttığı Covid-19 enfeksiyonu sürecinde Türkiye’de Solid organ nakilli hastaların başvuru sonuçlarının incelenmesidir. Metod: Girişimsel olmayan retrospektif gözlemsel dizayn edilen bu çalışmada; Mart 2020-Ocak 2021 tarihleri arasında Türkiye’de Covid-19 şüphesiyle hastaneye başvuran solid organ nakilli kişiler dahil edilmiştir. 14.463 olgunun Sağlık Bakanlığı bilgi sistemlerine kaydedilmiş klinik ve radyolojik parametreleri, servis ve yoğun bakım yatış ihtiyacı, yatış süreleri ve ölüm oranları incelenmiştir. Bulgular: Olguların %70,39’u (10.180) böbrek nakilli kişiler, %22’si (3245) karaciğer nakilli kişiler, %4,98’i (721) kalp nakli olmuş kişiler, %1,85’i (262) akciğer nakilliler, %0,21’ü (30) ince barsak nakilliler, %0,17’si (25) pankreas nakli olmuş kişilerden oluşuyordu. Tüm solid organ nakilli hastaların ortalama yatış oranı %86,7 idi. Solid organ nakilli hastalar değerlendirildiğinde COVID-19 tanısı konan 4307 hastanın %40,9’unda (1765) pnömoni saptandı, 1691’i (%39,2) hastaneye yatırılırken bu süre ortalama 10,08 gün idi. Yaş ortalamaları ise 48,83 ‘dü. Yoğun bakıma 448 (%10,4) vaka yatırıldı ve kalış süreleri 8,41 gün, ortalama yaşlarının da 57,4 ‘dü. COVID-19 tanısı alıp entübe olan solid organ nakilli hasta oranı %4,3 olup yatış süresi ortalama 7,6 gündü. Solid organ nakli olan tüm vakalarda toplam ölüm sayısı 318 (%2,19), ölenlerin yaş ortalaması 59,64 ‘du. COVID-19 tanısı almış tüm solid organ nakilli hastalarda ölüm oranı ise %7,38 olarak bulundu. Sonuç: COVID-19 pandemisi tibbi sosyal hizmetleri zorlaştırdığı göz önüne alındığında; Acil servislerde Solid organ nakli olan hastalar gibi hassas grupları izole etmenin, hızlı bir şekilde tanı ve yatış-taburcu kararı vermenin önemini ortaya koymaktadır. . Bu kararın; hem COVID-19 enfeksiyonunun sosyal hayatta hassas gruplarda yayılmasını azaltmada hem de enfeksiyon sonrası gelişebilecek pnömoni ve ötesi mortalitenin azaltılmasına katkı sağladığını, acil servislerde sosyal hizmet uygulamasının daha etkin olması için yeni önerilere ihtiyaç olduğunu düşünüyoruz.

Anahtar Kelimeler:

Acil servis, Tıbbi hizmet, Solid Organ nakilleri, covid-19, mortalite

INVESTIGATION OF EMERGENCY SERVICE AND HOSPITAL APPLICATIONS OF SOLID ORGAN TRANSPLANT PATIENTS INFECTED WITH COVID-19 IN TURKEY

Introduction: In the COVID-19 pandemic, the disease adversely affected family and community life due to its human-to-human transmission feature, spreading rapidly and creating an excessive increase in Emergency Service applications. Caring for sensitive patients, such as transplant patients, has also become difficult. Due to both family and community transmission, the care, evaluation, emergency diagnosis and hospitalization decision of these vulnerable patients are critical in the Emergency Departments. Our aim in this study is to examine the application results of solid organ transplant patients in Turkey during the Covid-19 infection period while emergency service applications are increasing.Method: In this non-invasive retrospective observational study; Between March 2020 and January 2021, solid organ transplant patients who applied to the hospital with the suspicion of Covid-19 in Turkey were included. The clinical and radiological parameters of 14,463 cases recorded in the information systems of the Ministry of Health, the need for hospitalization in the service and intensive care unit, length of stay and mortality rates were examined. Result: 70.39% (10.180) of the cases were kidney transplant recipients, 22% (3245) were liver transplant recipients, 4.98% (721) were heart transplant recipients, 1.85% (262) were lung transplant recipients , 0.21% (30) were small bowel transplant recipients, 0.17% (25) were pancreatic transplant recipients. The mean hospitalization rate of all solid organ transplant patients was 86.7%. When solid organ transplant patients were evaluated, pneumonia was detected in 40.9% (1765) of 4307 patients diagnosed with COVID-19, 1691 (39.2%) were hospitalized, with an average of 10.08 days. The mean age was 48.83. 448 (10.4%) cases were hospitalized in the intensive care unit, and their length of stay was 8.41 days and their mean age was 57.4 years. The rate of solid organ transplant patients diagnosed with COVID-19 and intubated was 4.3%, and the average length of stay was 7.6 days. The total number of deaths in all cases with solid organ transplantation was 318 (2.19%), and the mean age of those who died was 59.64 years. The mortality rate in all solid organ transplant patients diagnosed with COVID-19 was 7.38%. Conclusion: Considering that the COVID-19 pandemic complicates medical social services; It demonstrates the importance of isolating vulnerable groups such as patients with solid organ transplants in emergency departments and making a rapid diagnosis and hospitalization-discharge decision. We think that it contributes to both reducing the spread of COVID-19 infection in vulnerable groups in social life and reducing the post-infection pneumonia and beyond mortality, and that new recommendations are needed for more effective social work practice in emergency services.

Keywords:

Emergency service, Covid-19, mortality, Medical service, Solid Organ transplants,

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