Yoğun Bakımdaki COVID-19 Hastalarında Konvalesan Plazma: Ne Zaman Daha Etkili?

Amaç: Konvalesan plazma (CP) pandemilerde aşı ya da etkin ilaç tedavisi bulunana kadar faydalı olabileceği gösterilmiş bir immün tedavi yöntemidir. Özellikle COVID-19’da CP tedavisinin uygulanma zamanının sonuçlara etkisi tartışılmaktadır.Yoğun bakımda (YB) takip edilen COVID19’da erken ve geç dönem uygulanan CP tedavisinin, klinik ve laboratuvar sonuçlara etkilerini karşılaştırmak amaçlanmıştır. Gereç ve Yöntem: Bu retrospektif çalışmada etik kurul iznini takiben Mart-Aralık 2020 tarihlerinde yoğun bakımda CP alan PCR testi pozitif 152 hasta;erken tedavi (semptomlarının başlangıcı ile CP tedavisi arasında geçen süre ≤7 gün) ve geç tedavi (>7 gün) gruplarına ayrıldı. Hastaların laboratuvar değerleri ve klinik parametreleri dosyaları ve takip formları incelenerek kaydedildi. Çalışma grupları demografik ve klinik veriler, laboratuvar değerleri ve sağkalım açısından karşılaştırıldı (Tablo 1). Bulgular: Erken tedavi (n=82) ve geç tedavi (n=70) grupları arasında demografik özellikler, komorbiditeler, uygulanan solunum desteği, ilaç tedavileri, şok, organ yetmezliği gelişimi, yatış süresi, ventilatördeki gün sayısı ve mortalite açısından fark yoktu (Tablo 1). Laboratuvar tetkiklerinde, geç tedavi grubunda, tedavi öncesi ve sonrası 1. günde bakılan ferritin değerleri ve tedavi sonrası 3. günde bakılan CRP düzeyi, erken tedavi grubuna göre daha düşüktü (p<0,05). Sonuç: CP tedavisinin mortaliteyi azalttığına dair çalışmalar bulunmaktadır. Enfeksiyonun erken döneminde uygulanması ile tedavinin etkinliğinin arttığına dair sonuçlar bulunmakla birlikte daha geç uygulanması sonrası da olumlu sonuçların elde edildiği çalışmalar görülmektedir. Araştırmamızda tedavi zamanının klinik ve sağkalım açısından farklılık yaratmadığı gözlendi. Kullanılan plazmalardaki antikor titresinin bilinememesinin tedavi etkinliğini değerlendirmede belirsizlik yaratabileceği düşüncesindeyiz. Ayrıca geç tedavi grubundaki ferritin ve CRP düşüklüğünü bu gruptaki hastaların enflamasyon düzeylerinin daha hafif olmasına bağladık. CP tedavisinin erken veya geç dönemde uygulanması klinik ve sağkalım açısından farklılık yaratmamaktadır, COVID-19’un aşısı bulunmuş olmakla birlikte aşısız ve ağır komorbiditeli COVID-19 hastaları açısından CP tedavilerinin ileri çalışmalarla incelenmeye devam edilmesi gerektiği kanısındayız. [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Does hospitalisation of a patient in the intensive care unit cause anxiety and does restriction of visiting cause depression for the relatives of these patients during COVID-19 pandemic?

OBJECTIVES: During the pandemic, anxiety and depression may occur increasingly in the whole society. The aim of this study was to evaluate the possible cause, incidence and levels of anxiety and depression in the relatives of the patients in the intensive care unit (ICU) in accordance with the patients' SARS-CoV-2 polymerase chain reaction (PCR) result. MATERIALS AND METHOD: The study was prospectively conducted on relatives of patients admitted to tertiary intensive care units during COVID-19 pandemic. Sociodemographic characteristics of the patients and their relatives were recorded. "The Turkish version of the Hospital Anxiety and Depression Scale" was applied twice to the relatives of 120 patients to determine the symptoms of anxiety and depression in accordance with the PCR results of the patients (PCR positive n = 60, PCR negative n = 60). RESULTS: The ratios above cut-off values for anxiety and depression among relatives of the patients were 45.8% and 67.5% for the first questionnaire and 46.7% and 62.5% for the second questionnaire, respectively. The anxiety and depression in the relatives of PCR-positive patients was more frequent than the PCR negative (P < .001 for HADS-A and P = .034 for HADS-D). The prevalence of anxiety and depression was significantly higher in female relatives (P = .046 for HADS-A and P = .009 for HADS-A). There was no significant correlation between HADS and age of the patient or education of the participants. The fact that the patients were hospitalised in the ICU during the pandemic was an independent risk factor for anxiety (AUC = 0.746) while restricted visitation in the ICU was an independent risk factor for depression (AUC = 0.703). CONCLUSION: Positive PCR and female gender were associated with both anxiety and depression while hospitalisation in the ICU due to COVID-19 was an independent risk factor for anxiety and restricted visitation in the ICU is an independent risk factor for depression.

Clinical and laboratory features of COVID-19: Predictors of severe prognosis.

BACKGROUND: Coronavirus disease 2019 (COVID-19) emerged first in December 2019 in Wuhan, China and quickly spread throughout the world. Clinical and laboratory data are of importance to increase the success in the management of COVID-19 patients. METHODS: Data were obtained retrospectively from medical records of 191 hospitalized patients diagnosed with COVID-19 from a tertiary single-center hospital between March and April 2020. Prognostic effects of variables on admission among patients who received intensive care unit (ICU) support and those who didn't require ICU care were compared. RESULTS: Patients required ICU care (n = 46) were older (median, 71 vs. 43 years), with more underlying comorbidities (76.1% vs. 33.1%). ICU patients had lower lymphocytes, percentage of large unstained cell (%LUC), hemoglobin, total protein, and albumin, but higher leucocytes, neutrophils, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocytes ratio (PLR), urea, creatinine, aspartate amino transferase (AST), lactate dehydrogenase (LDH), and D-dimer when compared with non-critically ill patients (p < 0.001). A logistic regression model was created to include ferritin, %LUC, NLR, and D-dimer. %LUC decrease and D-dimer increase had the highest odds ratios (0.093 vs 5.597, respectively) to predict severe prognosis. D-dimer, CRP, and NLR had the highest AUC in the ROC analysis (0.896, 0.874, 0.861, respectively). CONCLUSIONS: The comprehensive analysis of clinical and admission laboratory parameters to identify patients with severe prognosis is important not only for the follow-up of the patients but also to identify the pathophysiology of the disease. %LUC decrease and D-dimer, NLR, and CRP increases seem to be the most powerful laboratory predictors of severe prognosis.