ABSTRACT
Objective: The Covid-19 pandemic has revealed the importance of an evidence-based efficient triage system in the early identification of high risk patients and the rational use of limited medical resources for reducing mortality. The aim of this study was to evaluate the role of various inflammatory indices that can be easily calculated using readily accessible, inexpensive routine test parameters in risk stratification and prediction of prognosis in patients with Covid-19. Material and Methods: The study was carried out retrospectively with the data of 8036 patients with Covid-19, who were grouped according to their prognosis in outpatient and inpatient follow-ups, and inpatients as survivors and death. Using the complete blood count and C-reactive protein baseline results of the patients at admission, neutrophillymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocytelymphocyte ratio (MLR), MVP-platelet ratio (MPR), platelet mass index (PMI), systemic immune-inflammatory index (SII), systemic inflammatory response index (SIRI), and multi-inflammatory indices (MII) were calculated. Results: Our results demonstrate that almost all of the inflammatory indices were significantly different in severe patients and in patients with high mortality risk, but not all of them had a predictive value. It has been seen that the most effective factors in determining the disease severity at the onset of Covid-19 are SIRI and age, and SII, MII-1 and MII-3 may also contribute to this prediction. Our results have also revealed that NLR is the most effective independent factor to predict mortality both at disease onset and for inpatients. Conclusion: Inflammatory indices, especially SIRI, NLR, SII, MII-1 and MII-3 can substantially contribute to clinical decisions in the early identification of high-risk patients and predicting mortality beginning from the onset of Covid-19.
ABSTRACT
Many countries have started their vaccination program against the ongoing COVID-19 pandemic. One of these countries, the Republic of Turkey began to use the CoronaVac vaccine and a large number of people in the country have been vaccinated so far. The efficacy rate of CoronaVac vaccine 14 days after two doses was reported as 83% for cases requiring medical treatment and 100% for hospitalization or severe-mortal cases. In addition, in a recent study, it was reported that Coronavac vaccine prevented 86.5% death due to covid-19 in the population over 60 years old, 14 days after receiving two doses of CoronaVac. The effectiveness of the vaccine in subgroups such as patients exposed to SARS-CoV-2 virus in less than 14 days, advanced age, comorbidity, and immunosuppression is not yet known. In addition, its effectiveness against different variants of the SARS-CoV-2 virus is not clear. An 85-year-old female patient with a positive SARS-CoV-2 Variant VOC-202012/01 Polymerase Chain Reaction test was admitted to the emergency department with dyspnea. The patient, whose tachycardia, tachypnea and auxiliary respiratory muscle use continued despite 60 L / min of 100% oxygen therapy with a high flow nasal cannula and whose PaO2 / fiO2 ratio was 63, was intubated. Bilateral widespread multifocal ground glass densities consistent with COVID-19 were observed in the thorax computed tomography. The patient, who was followed up in the intensive care unit, died on the 11th day of her follow-up. There are no cases of severe COVID-19 disease reported in the literature yet after the CoronaVac vaccine. In this case report, we present a severe COVID-19 patient with a positive PCR test for SARS-CoV-2 Variant VOC-202012/01 11 days after the second dose of CoronaVac administration. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.
ABSTRACT
Each country has different treatment and home isolation recommendations regarding the management of mild COVID-19 patients, and there is not yet a standard approach. The aim of this study is to determine which patients are suitable for home isolation by identifying the variables that predict the progression of the disease in mild COVID-19 patients. This prospective observational study included laboratory confirmed mild COVID-19 patients older than 18 years. The primary outcome of the study was the disease progression in mild COVID-19 patients. A multivariate regression model was created according to the results of univariate analyses. A total of 254 patients included in the study. Median age of the patients was 34.5 years (27-42), and 132 (52%) of them were male. COVID-19 compatible thoracic computed tomography appearance (P<0.001, HR=6.58, 95% CI=2.60-16.65) and advanced age (P=0.008, HR=1.07, 95% CI=1.02-1.13) were significantly associated with the progression of the disease, and the use of hydroxychloroquine (P=0.002, HR=0.09, 95% CI=0.02-0.32) was significantly associated with a decrease in the disease progression. The advanced age and COVID-19 compatible thoracic computed tomography appearance were associated with progression of the disease, while hydroxychloroquine treatment was associated with decreased progression in mild COVID-19 patients.