Sili Uluhan, Ay Pınar, Bilgin Hüseyin, Topuzoğlu Ahmet, Tükenmez-Tigen Elif, Ertürk-Şengel Buket, Yağçı-Çağlayık Dilek, Balcan Baran, Kocakaya Derya, Olgun-Yıldızeli Şehnaz, Gül Fethi, Bilgili Beliz, Can-Sarınoğlu Rabia, Karahasan-Yağcı Ayşegül, Mülazimoğlu-Durmuşoğlu Lütfiye, Eryüksel Emel, Odabaşı Zekaver, Direskeneli Haner, Karakurt Sait, Korten Volkan
Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, İstanbul, Turkey.
Equal contribution.
Infect Dis Clin Microbiol. 2023 Jun 23;5(2):94-105. doi: 10.36519/idcm.2023.206. eCollection 2023 Jun.
This study aimed to define the predictors of critical illness development within 28 days postadmission during the first wave of the COVID-19 pandemic.
We conducted a prospective cohort study including 477 PCR-positive COVID-19 patients admitted to a tertiary care hospital in Istanbul from March 12 to May 12, 2020.
The most common presenting symptoms were cough, dyspnea, and fatigue. Critical illness developed in 45 (9.4%; 95% CI=7.0%-12.4%) patients. In the multivariable analysis, age (hazard ratio (HR)=1.05, <0.001), number of comorbidities (HR=1.33, =0.02), procalcitonin ≥0.25 µg/L (HR=2.12, =0.03) and lactate dehydrogenase (LDH) ≥350 U/L (HR=2.04, =0.03) were independently associated with critical illness development. The World Health Organization (WHO) ordinal scale for clinical improvement on admission was the strongest predictor of critical illness (HR=4.15, <0.001). The patients hospitalized at the end of the study period had a much better prognosis compared to the patients hospitalized at the beginning (HR=0.14; =0.02). The C-index of the model was 0.92.
Age, comorbidity number, the WHO scale, LDH, and procalcitonin were independently associated with critical illness development. Mortality from COVID-19 seemed to be decreasing as the first wave of the pandemic advanced.
Graphic Abstract.
本研究旨在确定2019冠状病毒病（COVID-19）大流行第一波期间入院后28天内危重症发生的预测因素。
我们进行了一项前瞻性队列研究，纳入了2020年3月12日至5月12日在伊斯坦布尔一家三级护理医院收治的477例PCR检测呈阳性的COVID-19患者。
最常见的首发症状为咳嗽、呼吸困难和疲劳。45例（9.4%；95%置信区间=7.0%-12.4%）患者发展为危重症。在多变量分析中，年龄（风险比（HR）=1.05，<0.001）、合并症数量（HR=1.33，=0.02）、降钙素原≥0.25μg/L（HR=2.12，=0.03）和乳酸脱氢酶（LDH）≥350 U/L（HR=2.04，=0.03）与危重症发生独立相关。世界卫生组织（WHO）入院时临床改善的序贯量表是危重症最强的预测因素（HR=4.15，<0.001）。与研究期开始时住院的患者相比，研究期结束时住院的患者预后要好得多（HR=0.14；=0.02）。该模型的C指数为0.92。
年龄、合并症数量、WHO量表、LDH和降钙素原与危重症发生独立相关。随着大流行第一波的推进，COVID-19的死亡率似乎在下降。
图形摘要。
