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Sili U, Ay P, Bilgin H, Topuzoğlu A, Tükenmez-Tigen E, Ertürk-Şengel B, Yağçı-Çağlayık D, Balcan B, Kocakaya D, Olgun-Yıldızeli Ş, Gül F, Bilgili B, Can-Sarınoğlu R, Karahasan-Yağcı A, Mülazimoğlu-Durmuşoğlu L, Eryüksel E, Odabaşı Z, Direskeneli H, Karakurt S, Korten V. Factors Associated with 28-day Critical Illness Development During the First Wave of COVID-19. Infect Dis Clin Microbiol 2023; 5:94-105. [PMID: 38633015 PMCID: PMC10985825 DOI: 10.36519/idcm.2023.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/25/2023] [Indexed: 04/19/2024]
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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Affiliation(s)
- Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology,
Marmara University School of Medicine, İstanbul, Turkey
- Equal contribution
| | - Pınar Ay
- Department of Public Health, Marmara University School of
Medicine, İstanbul, Turkey
- Equal contribution
| | - Hüseyin Bilgin
- Department of Infectious Diseases and Clinical Microbiology,
Marmara University School of Medicine, İstanbul, Turkey
- Equal contribution
| | - Ahmet Topuzoğlu
- Department of Public Health, Marmara University School of
Medicine, İstanbul, Turkey
- Equal contribution
| | - Elif Tükenmez-Tigen
- Department of Infectious Diseases and Clinical Microbiology,
Marmara University School of Medicine, İstanbul, Turkey
| | - Buket Ertürk-Şengel
- Department of Infectious Diseases and Clinical Microbiology,
Marmara University School of Medicine, İstanbul, Turkey
| | - Dilek Yağçı-Çağlayık
- Department of Infectious Diseases and Clinical Microbiology,
Marmara University School of Medicine, İstanbul, Turkey
| | - Baran Balcan
- Department of Pulmonary Medicine, Marmara University School of
Medicine, İstanbul, Turkey
| | - Derya Kocakaya
- Department of Pulmonary Medicine, Marmara University School of
Medicine, İstanbul, Turkey
| | - Şehnaz Olgun-Yıldızeli
- Department of Pulmonary Medicine, Marmara University School of
Medicine, İstanbul, Turkey
| | - Fethi Gül
- Department of Anesthesiology and Intensive Care, Marmara
University School of Medicine, İstanbul, Turkey
| | - Beliz Bilgili
- Department of Anesthesiology and Intensive Care, Marmara
University School of Medicine, İstanbul, Turkey
| | - Rabia Can-Sarınoğlu
- Department of Medical Microbiology, Marmara University School of
Medicine, İstanbul, Turkey
| | | | | | - Emel Eryüksel
- Department of Pulmonary Medicine, Marmara University School of
Medicine, İstanbul, Turkey
| | - Zekaver Odabaşı
- Department of Infectious Diseases and Clinical Microbiology,
Marmara University School of Medicine, İstanbul, Turkey
| | - Haner Direskeneli
- Department of Internal Medicine, Marmara University School of
Medicine, İstanbul, Turkey
| | - Sait Karakurt
- Department of Pulmonary Medicine, Marmara University School of
Medicine, İstanbul, Turkey
| | - Volkan Korten
- Department of Infectious Diseases and Clinical Microbiology,
Marmara University School of Medicine, İstanbul, Turkey
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