Evaluation of the demographic and clinical characteristics of hospitalized COVID-19 patients in relation to prognosis

Background and Aim: The COVID-19 pandemic, which impacts the whole world and causes morbidity and mortality in millions of people, still continues to affect our country. Since the exact treatment of the disease is not yet known, which patient will be more severely affected by the disease at the time of admission and the factors affecting the prognosis are the most frequently asked questions about COVID-19. Therefore, in our study, we aimed to evaluate the demographic, clinical-laboratory data of COVID-19 cases hospitalized in the pandemic wards and intensive care units of our hospital in Rize, and to determine the factors affecting the duration of hospitalization and survival. Materials and Methods: This single center, retrospective, cross sectional, descriptive study was conducted between March 2020 and February 2021. COVID-19 patients older than 18 years of age, who were hospitalized in the pandemic wards or intensive care unit with appropriate clinical properties and PCR positivity or antibody presence confirmed by the ELISA method were included in the study. Patients under the age of 18, those with negative PCR tests, pregnant women and those with missing data in their files were excluded from the study. Patient data (demographic, clinical, laboratory and imaging) were collected retrospectively from the files and hospital records. The comorbidity scores of the patients were calculated using the modified Charlson comorbidity index. Length of hospital stay, need for intensive care and survival data were recorded. The patients were divided into groups according to the severity of pneumonia (uncomplicated, mild-moderate, and severe), mortality (deaths/survivors), and initial treatment responses (successful treatment/treatment failure). Factors associated with mortality were calculated by univariant logistic regression analysis. Results: The mean age of the 165 patients included in the study was 59±16 years (58% male). Of the patients, 57% were non-smokers, 38% were quitters, and 5% were active smokers. The most common comorbid diseases were hypertension (50.3%) and diabetes mellitus (25.5%). Compared to the uncomplicated (n: 18) and mild-to-moderate pneumonia (n: 75) groups, the severe pneumonia (n: 72) group consisted of older patients with male-predominance and higher modified Charlson comorbidity score. Patients with severe pneumonia had more frequent cough and shortness of breath; in addition, they had higher leukocyte, neutrophil, NLR, sedimentation, CRP, D-dimer, ferritin, serum creatinine, AST, LDH, troponin levels, and lower lymphocyte, total protein and serum albumin levels at the time of admission. It was found that patients with severe pneumonia had lower oxygen saturation, higher thorax CT scores at the time of admission, and a longer hospital stay during follow-up. Compared to the survivors, patients who died (n: 25) were older, male dominated, had higher modified Charlson comorbidity index scores (especially ischemic heart disease and chronic kidney disease), and higher smoking rates, were more dyspneic at presentation with longer hospital stays and had lower oxygen saturation and higher CT scores on admission. The laboratory parameters of the patients who died were found to have higher leukocyte, neutrophil, urea, creatinine, LDH, troponin, creatinine kinase, direct bilirubin, NLR, CRP, D-dimer, ferritin values, and lower lymphocyte, total protein and albumin values when compared to the survivors. When the first treatment success of drugs is evaluated; hydroxychloroquine was superior to favipiravir; in the follow-up, it was observed that the mortality of the patients who had steroids as an add-on therapy due to worsening clinical status was higher. As expected, the rate of intensive care hospitalization and tocilizumab and plasma therapy were higher in the group of patients who died. The univariant logistic xv regression analysis of mortality-related factors revealed that; advanced age, male gender, smoking, high modified Charlson index score (especially the presence of IHD and CKD), initial low oxygen saturation, high CT score at admission, and long hospital stay were the factors predicting mortality. Conclusion: The mortality rate is higher in elderly, male, dyspneic COVID-19 patients with high comorbidity, high lung CT score, impaired laboratory parameters and low oxygen saturation at baseline. These patients should be followed more closely from the first application. Other factors associated with poor prognosis are unresponsiveness to the initial treatment, the need to add steroids to the treatment regime due to clinical worsening, intensive care requirement, long hospital stay, and the need for additional treatments (tocilizumab and immune plasma therapy)