COVID-19 experience of the major pandemic response center in the capital: results of the pandemic’s first month in Turkey

Background/aim: The aim of this study is to evaluate the epidemiological and clinical characteristics and parameters that determined the clinical course and prognosis of the COVID-19 patients admitted to Ankara City Hospital during the first month of the pandemic in Turkey. Materials and methods: SARS-CoV-2 PCR positive patients who were hospitalized between March 10 and April 10, 2020 were included. Results: Among 222 patients, mean age was higher in severe acute respiratory illness (SARI)/critical disease group (P < 0.001). Median time from illness onset to admission and presence of comorbidity, especially coronary artery disease and chronic obstructive pulmonary disease, were significantly higher in the SARI/critical disease group (P < 0.05). Cough and fever were the most common symptoms, while anosmia and loss of taste were observed in 8.6% and 7.7% patients, respectively. The mortality rate was 5.4%. A high neutrophil/lymphocyte ratio; low lymphocyte, monocyte, and platelet count; elevated liver enzymes; low GFR; and high levels of muscle enzymes, ferritin, and IL-6 on admission were found to be associated with SARI/critical disease (P < 0.05). Bilateral ground-glass opacity and patchy infiltration were more frequently seen in the SARI/critical disease group (P < 0.001). Patients older than 65 years had an 8-fold increased risk for development of SARI/critical disease. Conclusion: This cohort study regarding COVID-19 cases in Turkey reveals that older age, presence of comorbidity, bilateral infiltration on CT, high neutrophil/lymphocyte ratio, low monocyte and platelet count, elevated liver enzymes, low GFR, high levels of muscle enzymes, and high levels of ferritin and IL-6 on admission are predictors of SARI and severe disease. Ankara Şehir Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Ankara, Türkiye

PDF

___

1. Zhu N, Zhang D, Wang W, Li X, Yang B et al. A novel coronavirus from patients with pneumonia in china, 2019. New England Journal of Medicine 2020; 382: 727-733. doi: 10.1056/NEJMoa2001017
2. Feng Y, Ling Y, Bai T, Xie Y, Huang J et al. COVID-19 with different severity: a multi-center study of clinical features. American Journal of Respiratory and Critical Care Medicine 2020 Jun 1; 201 (11): 1380-1388. doi: 10.1164/rccm.202002- 0445OC
3. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA 2020 Apr 22; 323 (20): 2052- 2059. doi: 10.1001/jama.2020.6775
4. Wang D, Hu B, Hu C, Zhu F, Liu X et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirusinfected pneumonia in Wuhan, China. JAMA 2020 Feb 7; 323 (11): 1061-1069. doi: 10.1001/jama.2020.1585
5. Guan W-J, Liang W-H, Zhao Y, Liang H-R, Chen Z-S et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. European Respiratory Journal 2020 May 14; 55 (5): 2000547. doi: 10.1183/13993003.00547-2020
6. CDC COVID-19 Response Team. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 – United States, February 12-March 28, 2020. MMWR Morbidity and Mortality Weekly Report 2020; 69: 382-386. doi: 10.15585/ mmwr.mm6913e2
7. Zheng Z, Peng F, Xu B, Zhao J, Liu H et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. Journal of Infection 2020 Apr 23: S0163-4453 (20) 30234-30236. doi: 10.1016/j.jinf.2020.04.021
8. Fosbøl EL, Butt JH, Østergaard L, Andersson C, Selmer C et al. Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use With COVID-19 Diagnosis and Mortality. JAMA 2020 Jun 19; e2011301. doi: 10.1001/ jama.2020.11301
9. Li J, Wang X, Chen J, Zhang H, Deng A. Association of reninangiotensin system inhibitors with severity or risk of death in patients with hypertension hospitalized for coronavirus disease 2019 (COVID-19) Infection in Wuhan, China. JAMA 2020 Apr 23; e201624. doi: 10.1001/jamacardio.2020.1624
10. Liu Y, Mao B, Liang S, Yang J-W, Lu H-W et al. Association between ages and clinical characteristics and outcomes of coronavirus disease 2019. European Respiratory Journal 2020 May; 55 (5): 2001112. doi: 10.1183/13993003.01112-2020
11. Xie J, Tong Z, Guan X, Du B, Qiu H. Clinical characteristics of patients who died of coronavirus disease 2019 in China. JAMA Network Open 2020; 3: e205619. doi: 10.1001/ jamanetworkopen.2020.5619
12. Tong JY, Wong A, Zhu D, Fastenberg JH, Tham T. The prevalence of olfactory and gustatory dysfunction in COVID-19 patients: a systematic review and meta-analysis. Otolaryngology– Head and Neck Surgery 2020; 194599820926473. doi: 10.1177/0194599820926473
13. Li L-Q, Huang T, Wang Y-Q, Wang Z-P, Liang Y et al. COVID-19 patients’ clinical characteristics, discharge rate, and fatality rate of meta-analysis. Journal of Medical Virology 92 (6): 577-583. doi: 10.1002/jmv.25757
14. Zhu J, Ji P, Pang J, Zhong Z, Li H et al. Clinical characteristics of 3,062 COVID-19 patients: a meta-analysis. Journal of Medical Virology. doi: 10.1002/jmv.25884
15. 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; 395: 1054-1062. doi: 10.1016/S0140-6736(20)30566-3
16. Zhang J, Yu M, Tong S, Liu L-Y, Tang L-V. Predictive factors for disease progression in hospitalized patients with coronavirus disease 2019 in Wuhan, China. Journal of Clinical Virology 127: 104392. doi: 10.1016/j.jcv.2020.104392
17. Wichmann D, Sperhake J-P, Lütgehetmann M, Steurer S, Edler C et al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study. Annals of Internal Medicine. doi: 10.7326/M20-2003