In patients diagnosed with COVID-19 applying to the emergency service; associating hematological, biochemical, cardiac parameters with radiological findings

Background-aim: SARS-CoV2 type COVID-19 disease, which started in Wuhan, China in December 2019, spread to the whole world in a short time and became a pandemic. Microbiological and radiological examinations are used for the diagnosis of COVID-19 infection. In addition biochemical and hematological tests are used in the risk grading of the disease and in the follow-up of the disease and treatment. RT-PCR(Realtime Reverse-Transcriptase Polymerase Chain Reaction) test is a reliable diagnostic test in diagnosing COVID-19, but it may not be suitable for quick decision making especially in emergency service applications due to long prompt-result time. In this study we correlated the hematological, biochemical and cardiac parameters of the patients diagnosed with COVID-19 who applied to the emergency department of our hospital with radiological findings. We investigated the role of all these in making the decision for discharge or hospitalization and discussed wheter these parameters would be effective in predicting the prognosis of the disease. Material-method: Our research is a retrospective study and adult patients over the age of 18 who applied to the emergency department of Manisa Celal Bayar University Hospital between September 2020 and September 2021, who were diagnosed with COVID-19 and tested positive for COVID-19 PCR, were included in the study. All parameters were recorded by scanning the patient files over the Hospital Information Management System(HIMS). Results: Of the 400 cases included in the study, 217(54.2%) were male. Of 193 patient with chronic disease 94(48.7%) had diabetes, 113(58.5%) hypertension, 10(19.3%) asthma, 29(15%) COPD(Chronic obstructive pulmonary desease), 44(22.8%) CAD(coronary artery disease). Chest X-Ray findings were found to be normal in 96(83.5%) of 115 patients who underwent chest X-ray, focal consolidation was found in 9(7.8%) cases and diffuse alveolar change was found in 8(7%). Of 283 patients with thoracic Computed Tomography(CT) findings, 19(6.7%) had very low suspicious Thorax CT findings , 18(6.4%) had low suspicious, 60(21.2%) had suspicious, 104(36.7%) had highly suspicious and 82(29%) had very highly suspicious. A statistically significant relationship was found between thorax CT and discharge status(χ2=22,913; p=0,000). It was determined that 76(55.9%) of the patients in the discharge group were female and 157(59.5%) of the hospitalized patients were male. There was a statistically significant difference between the groups in terms of urea, uric asid, creatinine, LDH, CRP, glucose, CK, albümin, globulin, ferritin, Na, Cl, Ca, PT, APTT, fibrinogen, D-Dimer, troponin, CK-MB(p<0,05). Those with chronic disease are 4.426 times more likely to be hospitalized than those without chronic disease(OR=4,426). It was determined that 92 patients (47.7%) who were hospitalized in the service had high suspicion in thoracic CT, and 29 patients (60.4%) who were hospitalized in the intensive care unit had very high suspicion in thoracic CT. It was determined that those who were admitted to the service had predominantly high suspicion in the thorax CT, and those who were admitted to the intensive care unit had predominantly very high suspicion. The urea, creatinine, LDH, CRP, glucose, ferritin, K, PT, D-dimer, troponin and CK-MB values of those admitted to the intensive care unit are significantly higher than those admitted to the service. It has been determined that chronic disease is an important parameter affecting intensive care hospitalizations(p<0,05). Those with chronic diseases are 10,954 times more likely to be admitted to intensive care units than those without chronic disease(OR=10,954). Hgb, Hct, PLT, Lymphocyte, Monocyte values of those with high suspicion of thorax CT are significantly lower than those with low suspicion. Conclusion: It was determined that the majority of patients with chronic diseases were hypertension and diabetes, and it was an important parameter affecting intensive care hospitalization. It should be evaluated by combining radiological imaging and laboratory findings in addition to RT-PCR test in order to reduce the workload in the emergency department and to conclude patients faster during periods of high patient density such as pandemics. In addition, these parameters have been proven to guide the prognosis of the disease. Keywords: COVID-19, Computed Thoracic Tomography, CO-RADS classification, service, intensive care,