ABSTRACT
Aim: The purpose of this study was to determine the host risk factors associated with mortality in COVID-19 patients who are hospitalized for pneumonia, and also, to find a COVID-19 mortality score based on these. Methods: All patients diagnosed as confirmed or probable COVID-19 pneumonia whom hospitalised in our Chest Diseases Education and Research Hospital between March 11, 2020 and October 1,2020 were enrolled. The optimal cut-off values, sensitivity and specificity values and odds ratios to be used in mortality prediction of the novel scoring system created from these parameters were calculated by ROC analysis according to the area under the curve and Youden index. Results: Over 422 patients (n: 51 mortal, n: 371 survivors) univariate regression analysis showed that age, male gender, smoking, comorbidity, and using ACE inhibitor were prognostic host risk factors for COVID-19-related mortality. Using this analysis, a novel scoring model Co-AMSCA (Age, Male, Smoking history, Comorbidity, ACE inh)was established. The cut-off value of this scoring system (including only host risk factors), which determines the mortality risk in patients, was 3.5 points with 88.4% sensitivity and 65.5 % specificity (AUC = 0.761, 95% CI 0.697-0.826, P < .001) (Figure 1). The mortality risk in patients with a Co-AMSCA mortality score above 3.5 points was 7.8 times higher than patients with lower than 3.5 (OR= 7.8; P < .001).In multivariate logistic regression analysis, older age and smoking (smoker/ex-smoker) were found to be important risk factors for mortality (OR = 12.09; 95% CI 2,564-57,054 P =0.004 and OR = 3.1; 95% CI 1,381-7,295; P = 0.007,respectively). Counclusion:We created a simple mortality score, which is easily calculated and does not require laboratory and time.This study showed that by using Co-AMSCA mortality score that has only host risk factors achieved a prediction of mortality in COVID-19 patients who are hospitalized for pneumonia.
Subject(s)
COVID-19 , Chest Pain , PneumoniaABSTRACT
Background Knowledge of predisposing factors in developing pulmonary thromboembolism (PTE) is important in the diagnosis and treatment approach. The association between past coronavirus disease-19 (COVID-19) infection and PTE is a potential research topic. In this study we aimed to determine the prevalence of previous COVID-19 in addition to all predisposing factors for PTE development and to determine whether there is a difference in embolism severity in these cases.Methods Study design: Multicenter, observational, cross-sectional. Patients diagnosed with PTE between March 11, 2022, and March 11, 2023, were prospectively included in the study. Group 1: PTE cases with previous COVID-19, Group 2: PTE cases without previous COVID-19. To compare the categorical variables between groups the chi-square test was used. For continuous variables, parametric and non-parametric tests were used. Multivariate binary logistic regression analysis was performed to determine the independent variables related to PTE severity that affected the presence of previous COVID-19.Results Forty-four researchers from 33 centers participated in our study. A total of 1185 patients were included (Group 1; n = 360, Group 2; n = 825). The median post-COVID duration was 120.0 (min-max: 30–980) days. Computed tomography pulmonary angiography (CTPA) right ventricle/left ventricle (RV/LV) ratio > 1 was significantly higher in Group 2 compared to Group 1 (27.9% vs 19.7%, p = 0.003).The proportion of patients receiving systemic thrombolytic drugs (11.3% vs. 7.5%, p = 0.048), and the rate of patients who started treatment in the intensive care unit was higher in Group 2 (23.4% vs. 14.7%, p = 0.001). In multivariate logistic regression analysis, the absence of any identifiable risk factor for PTE was found to be a 0.46-fold protective factor in the presence of previous COVID-19 (95% CI: 0.274–0.760, p = 0.003) and an RV/LV ratio > 1 on CTPA was found to be a 0.60-fold protective factor (95% CI: 0.365–0.998, p = 0.049).Conclusions The prevalence of previous COVID-19 infection in PTE cases was 30.4%, and 26% of idiopathic cases had previous COVID-19 infection. Although the parameters related to embolism severity were higher in the non-COVID-19 group, in multivariate analyses, only idiopathic status was associated with a 2.2-fold increased risk in non-COVID-19 patients compared to those who had, and an RV/LV ratio > 1 on CTPA was associated with a 1.7-fold increased risk.