Selçuk YAYLACI, Yakup TOMAK, Mehmet KÖROĞLU, Oğuz KARABAY, Yusuf AYDEMİR, İbrahim KOCAYİĞİT, Ali Fuat ERDEM, Kezban ÖZMEN SÜNER, Havva KOCAYİĞİT, Gürkan DEMİR, Mehmet Halil ÖZTÜRK

Characteristics and outcomes of critically ill patients with covid-19 in Sakarya, Turkey: a single centre cohort study

Background/aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Turkey on March 10, 2020 and the number of the patients are increasing day by day. Coronavirus disease 2019 (Covid-19) has high mortality rates in intensive care units (ICUs). We aimed to describe the demographic characteristics, comorbidities, treatment protocols, and clinical outcomes among the critically ill patients admitted to the ICU of our hospital. Materials and methods: This cohort study included 103 consecutive patients who had laboratory confirmed Covid-19 and admitted to ICU of Sakarya University Training and Research Hospital between March 19 and April 13, 2020. The final date of the follow-up was April 18. Results: The mean age of the patients was 69.6 ± 14.1 years. Most of the patients had increased CRP (99%), serum ferritin (73.8%), d-dimer (82.5%), and hs-troponin levels (38.8%). 34 patients (33%) had lymphocytopenia, 24 patients (23.3%) had thrombocytopenia. 63 patients (61.2%) developed acute respiratory distress syndrome (ARDS), 31 patients (30.1%) had acute kidney injury, and 52 patients (50.5%) had multiple organ dysfunction syndrome (MODS) during follow-up. Sixty-two patients (60.2%) received mechanical ventilation. As of April 18, of the 103 patients, 52 (50.5%) had died, 30 (29.1%) had been discharged from the ICU, 21 (20.4%) were still in the ICU. Conclusions: Covid-19 has high mortality rates in ICU. Patients with elevated procalcitonin, hs-troponin, d-dimer, and CRP levels and lower platelet count at admission have higher mortality.Key words: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), coronavirus disease 2019 (Covid-19), intensive care unit

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1. World Health Organization. Novel coronavirus—China. http:// www.who.int/csr/don/12-january-2020-novel-coronaviruschina/en/ accessed June 12; 2020
2. Center for Systems Science and Engineering. Coronavirus COVID-19 global cases.https://gisanddata. maps.arcgis.com/apps/opsdashboard/index.html#/ bda7594740fd40299423467b48e9ecf6 Accessed June 12;2020
3. Republic of Turkey Ministry of Health. https://covid19bilgi. saglik.gov.tr/tr/gunluk-vaka.html. Accessed April 18; 2020
4. Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72, 314 cases from the Chinese Center for Disease Control and Prevention. Journal of American Medical Association 2020; 323 (13): 1239-1242 doi:10.1001/jama.2020.2648 5. Yang X, Yu Y, Xu J, Shu H, Xia J et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respiratory Medicine 2020; 8 (5): 475-481. doi:10.1016/S2213-2600(20)30079-5
6. Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. Journal of American Medical Association 2020. doi: 10.1001/ jama.2020.4031
7. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance. Published Jan 28, 2020. Accessed Apr 23, 2020.
8. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E et al. ARDS definition task force. Acute respiratory distress syndrome: the Berlin definition. Journal of American Medical Association 2012; 307 (23): 2526-2533. doi: 10.1001/ jama.2012.5669
9. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice 2012; 120 (4): 179-184. doi: 10.1159/000339789
10. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.. Chest 1992; 101 (6): 1644-1655. doi: 10.1378/chest.101.6.1644
11. Zhou F, Yu T, Du R, Fan G, Liu Y et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020 28; 395 (10229): 1054-1062. doi: 10.1016/S0140-6736(20)30566-3
12. Huang C, Wang Y, Li X, Ren L, Zhao J et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506. doi: 10.1016/S0140- 6736(20)30183-5
13. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ et al. Characteristics of coronavirus disease 2019 in China. New England Journal of Medicine 2020; 382 (18): 1708-1720. doi: 10.1056/ NEJMoa2002032
14. Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. Journal of American Medical Association 2020; 323 (16): 1612-1614. doi: 10.1001/ jama.2020.4326
15. Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR et al. Covid 19 in critically ill patients in the Seattle region - case series. New England Journal Medicine 2020; 382 (21): 2012-2022. doi: 10.1056/NEJMoa2004500
16. Schädler D, Porzelius C, Jörres A, Meier-Hellmann A, Brederlau J et al. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: a randomized controlled trial. PLoS One 2017; 12 (10): e0187015. doi: 10.1371/journal.pone.0187015
17. Venkatareman R, Subramanian S, Kellum JA. Clinical review: extracorporeal blood purification in severe sepsis. Critical Care 2003; 7: 139. doi:10.1186/cc1889
18. Chen J, Han W, Chen J, Zong W, Wang W et al. High performance of a unique mesoporous polystyrene-based adsorbent for blood purification. Regen Biomater 2017; 4 (1): 31-37. doi: 10.1093/rb/rbw038
19. Ma J, Xia P, Zhou Y, Liu Z, Zhou X et al. Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19. Clinical Immunology 2020; 214: 108408. doi: 10.1016/j.clim.2020.108408
20. Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID-19. Journal of Cardiovascular Electrophysiology 2020; 31 (5): 1003-1008. doi: 10.1111/jce.14479
21. Shi S, Qin M, Shen B, Cai Y, Liu T et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. Journal of American Medical Association Cardiology 2020; e200950. doi: 10.1001/jamacardio.2020.0950
22. Guo T, Fan Y, Chen M, Wu X, Zhang L et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). Journal of American Medical Association Cardiology 2020; e201017. doi: 10.1001/ jamacardio.2020.1017
23. Ding L, Wang L, Ma W, He H. Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: a multi-centre prospective cohort study. Critical Care 2020; 24 (1): 28. doi: 10.1186/s13054-020- 2738-5
24. Ghelichkhani P, Esmaeili M. Prone position in management of COVID-19 patients; a commentary. Archives of Academic Emergency Medicine 2020; 8 (1) : e48. doi: 10.1111/apa.15382
25. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next?. Lancet 2020; 395 (10231): 1225‐1228. doi: 10.1016/ S0140-6736(20)30627-9
26. Wang ZH, Shu C, Ran X, Xie CH, Zhang L. Critically ill patients with Coronavirus disease 2019 in a designated ICU: clinical features and predictors for mortality. Risk Management Healthcare Policy 2020; 13: 833-845. doi: 10.2147/RMHP. S263095