Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey.
Department of Pulmonary Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
Respir Med. 2021 Jul;183:106433. doi: 10.1016/j.rmed.2021.106433. Epub 2021 Apr 28.
The COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5-5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6-23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored.
本研究旨在评估土耳其的 COVID-19 死亡率和相关的危险因素。我们回顾性评估了 2020 年 3 月 11 日至 7 月 31 日期间在 26 个中心住院的 1500 名 COVID-19 成年患者。在研究组中，1041 例和 459 例分别被诊断为明确病例和高度可能病例。有 993 例 PCR 阳性病例（66.2%）。在所有病例中，1144 例（76.3%）被诊断为非严重肺炎，而 212 例（14.1%）为严重肺炎。67 例患者死亡，死亡率为 4.5%（95%CI：3.5-5.6）。单因素分析表明，包括男性、年龄≥65 岁以及呼吸困难或意识障碍、恶性肿瘤、慢性阻塞性肺疾病、间质性肺病、免疫抑制状态、严重肺炎、多器官功能障碍和脓毒症等在内的多种因素与死亡率呈正相关。法匹拉韦、羟氯喹和阿奇霉素与生存率无关。多因素分析后发现，男性、严重肺炎、多器官功能障碍、恶性肿瘤、脓毒症和间质性肺病是死亡率的独立危险因素。在生物标志物中，入院第 3-5 天降钙素原水平与死亡率的相关性最强（OR：6.18；1.6-23.93）。本研究表明，COVID-19 大流行早期住院患者的死亡率是一个严重威胁，男性、严重肺炎、多器官功能障碍、恶性肿瘤、脓毒症和间质性肺病患者的死亡率增加；因此，此类患者应密切监测。
