Clinical Features of the 60 Years and Older Patients Infected with 2019 Novel Coronavirus: Can We Predict Mortality Earlier?

INTRODUCTION: The novel coronavirus (COVID-19), which has affected over 100 countries in a short while, progresses more mortally in elderly patients with comorbidities. In this study, we examined the epidemiological, clinical, and laboratory characteristics of the patients aged 60 and over who had been infected with COVID-19. METHODS: The data of the patients admitted to the hospital within 1 month from May 8, 2020 onwards and hospitalized for COVID-19 pneumonia were obtained from the hospital medical records, and the epidemiological, clinical, and laboratory parameters of the patients during the admission to the emergency department were examined. Patients were divided into 2 groups regarding the criteria of having in-hospital mortality (mortality group) and being discharged with full recovery (survivor group). The factors, which could have an impact on the mortality, were investigated using a univariate and multivariate logistic regression analysis. RESULTS: This retrospective study included 113 patients aged 60 years and older, with a confirmed diagnosis of COVID-19 pneumonia. The mean age of the patients was 70.7 ± 7.9, and 64.6% (n = 73) of them were male. The mortality rate was 19.4% (n = 22). Among the comorbid illnesses, only renal failure was significant in the mortality group (p = 0.04). A CURB-65score ≥3 or pneumonia severity index (PSI) class ≥4 manifested a remarkable discrimination ability to predict 30-day mortality (p < 0.001). When the laboratory parameters were considered, the value of neutrophil to lymphocyte ratio (NLR) was significant in predicting mortality in univariate and multivariate analysis (odds ratio [OR] = 1.11; 95% confidence interval [95% CI], 1.03-1.21; p = 0.006, and OR = 1.51; 95% CI, 1.11-2.39; p = 0.044, respectively). CONCLUSION: In our study, NLR was determined to be an independent marker to predict in-hospital mortality among patients with COVID-19. PSI and CURB-65 revealed a considerably precise prognostic accuracy for the patients with COVID-19 in our study as well. Moreover, thanks to that NLR results in a very short time, it can enable the clinician to predict mortality before the scoring systems are calculated and hasten the management of the patients in the chaotic environment of the emergency room.

Recurrence of COVID-19 Documented with RT-PCR.

We present a case of coronavirus disease 2019 (COVID-19) re-infection where the time interval between two COVID-positive episodes is the longest in the literature. A 40-year male patient was admitted to the Emergency Department with  complaints of sore throat, cough and diarrhea; and was re-diagnosed as COVID-19 positive after a virus-free period. He did not have a chronic disease in his anamnesis and used no medication. After COVID-19 infection and a long recovery period, he became COVID-19 positive again. In this case, the time to second COVID-19 infection was 94 days from the first positive PCR test and 86 days from the complete resolution of symptoms. This is one of the longest COVID-19-free period between two episodes of infection in the literature. Key Words: COVID-19, Recurrence, Re-infection, Recovery.

Recurrence of COVID-19 Documented with RT-PCR.

We present a case of coronavirus disease 2019 (COVID-19) re-infection where the time interval between two COVID-positive episodes is the longest in the literature. A 40-year male patient was admitted to the Emergency Department with complaints of sore throat, cough and diarrhea; and was re-diagnosed as COVID-19 positive after a virus-free period. He did not have a chronic disease in his anamnesis and used no medication. After COVID-19 infection and a long recovery period, he became COVID-19 positive again. In this case, the time to second COVID-19 infection was 94 days from the first positive PCR test and 86 days from the complete resolution of symptoms. This is one of the longest COVID-19-free period between two episodes of infection in the literature. Key Words: COVID-19, Recurrence, Re-infection, Recovery.

Investigation of QT Prolongation with Hydroxychloroquine and Azithromycin for the Treatment of COVID-19.

OBJECTIVE: To assess and identify the risk of prolonged QT about hydroxychloroquine (HQ) and azithromycin (AZ) used in the treatment of patients with COVID-19. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Turkey, from March to May 2020. METHODOLOGY: One hundred and forty-four patients with the diagnosis of COVID-19, confirmed by Rt-PCR (reverse transcription-polymerase chain reaction), were restrospectively reviewed. Patients who were hospitalised, received HQ or HQ plus AZ treatment, had a baseline electrocardiogram (ECG), and had at least one ECG after treatment were included in the study. Patients with missing data were excluded. RESULTS: Fifty-one (35.4%) patients were given hydroxychloroquine monoterapy (HQ), 93 (64.6%) were given hydroxychloroquine plus azithromycin (HA), and 70 (48.6%) were women. Pre-treatment mean QTc measurements were calculated as 410.61 ± 29.44 milliseconds (ms) for HQ group and 412.02 ± 25.37 ms for HA group, while the mean values of post-treatment QTc measurements were calculated as 432.31 ± 33.97 ms for HQ group and 432.03 ± 27.0 ms for the HA group. Post-treatment QTc measurements of both HA group and HQ group were prolonged compared to pre-treatment measurements. Ventricular arrhythmia was not observed in any patient. CONCLUSION: For COVID-19, no globally accepted definite treatment has yet been found. Both of hydroxychloroquine monotherapy and hydroxychloroquine plus azithromycin treatment regimens cause QTc measurement to increase at a statistically significant level. We concluded that this increase in QTc did not cause ventricular arrhythmia. Key Words: COVID-19, QTc interval, Hydroxychloroquine, Azithromycin.