Factors Associated with 28-day Critical Illness Development During the First Wave of COVID-19.

IF 3.8 3区医学 Q2 CELL & TISSUE ENGINEERING Stem Cells International Pub Date : 2023-06-23 eCollection Date: 2023-06-01 DOI:10.36519/idcm.2023.206

Uluhan Sili, Pınar Ay, Hüseyin Bilgin, Ahmet Topuzoğlu, Elif Tükenmez-Tigen, Buket Ertürk-Şengel, Dilek Yağçı-Çağlayık, Baran Balcan, Derya Kocakaya, Şehnaz Olgun-Yıldızeli, Fethi Gül, Beliz Bilgili, Rabia Can-Sarınoğlu, Ayşegül Karahasan-Yağcı, Lütfiye Mülazimoğlu-Durmuşoğlu, Emel Eryüksel, Zekaver Odabaşı, Haner Direskeneli, Sait Karakurt, Volkan Korten

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Abstract

Objective: This study aimed to define the predictors of critical illness development within 28 days postadmission during the first wave of the COVID-19 pandemic.

Materials and methods: 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.

Results: 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, p<0.001), number of comorbidities (HR=1.33, p=0.02), procalcitonin ≥0.25 µg/L (HR=2.12, p=0.03) and lactate dehydrogenase (LDH) ≥350 U/L (HR=2.04, p=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, p<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; p=0.02). The C-index of the model was 0.92.

Conclusion: 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: Graphic Abstract.

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COVID-19 第一波期间与 28 天危重病发展相关的因素。

研究目的本研究旨在确定 COVID-19 大流行第一波期间入院后 28 天内危重病发展的预测因素：我们开展了一项前瞻性队列研究，研究对象包括伊斯坦布尔一家三级医院在 2020 年 3 月 12 日至 5 月 12 日期间收治的 477 名 PCR 阳性 COVID-19 患者：最常见的症状是咳嗽、呼吸困难和疲劳。45例（9.4%；95% CI=7.0%-12.4%）患者出现危重症。在多变量分析中，年龄（危险比（HR）=1.05，PP=0.02）、降钙素原≥0.25 µg/L（HR=2.12，P=0.03）和乳酸脱氢酶（LDH）≥350 U/L（HR=2.04，P=0.03）与危重症的发生独立相关。世界卫生组织（WHO）对入院时临床改善情况的序数量表是预测危重症的最强指标（HR=4.15，pp=0.02）。模型的 C 指数为 0.92：结论：年龄、合并症数量、WHO量表、LDH和降钙素原均与危重症的发生独立相关。随着第一波大流行的推进，COVID-19 导致的死亡率似乎在下降。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Stem Cells International CELL & TISSUE ENGINEERING-

CiteScore

8.10

自引率

2.30%

发文量

188

审稿时长

18 weeks

期刊介绍： Stem Cells International is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all areas of stem cell biology and applications. The journal will consider basic, translational, and clinical research, including animal models and clinical trials. Topics covered include, but are not limited to: embryonic stem cells; induced pluripotent stem cells; tissue-specific stem cells; stem cell differentiation; genetics and epigenetics; cancer stem cells; stem cell technologies; ethical, legal, and social issues.