Tocilizumab is useful for coronavirus disease 2019 patients: the key point is timing.

OBJECTIVE: In coronavirus disease 2019, a rapidly progressive inflammatory process is considered to be the main cause of organ damage and mortality. Therefore, the importance of anti-inflammatory treatments such as tocilizumab is increasing. METHODS: A total of 107 patients who received tocilizumab between March 2020 and March 2021 were included in the study. The primary termination point was mortality. We compared surviving and deceased patients by the stage of the disease and where the drug was given (service or intensive care unit). RESULTS: The mean age was 60.8±14.6 years (minimum 29 years, maximum 96 years). According to the WHO staging system, 16 (15%) patients had moderate, 47 (43.9%) patients had severe, 44 (41.1%) patients had a critical illness. Although all patients were admitted to the service, 26 (24.3%) patients received tocilizumab in the intensive care unit. Of 107 patients, 80 (74.7%) survived and 27 (25.2%) died. Mortality was found to be significantly higher in critical patients (96.3%), severe patients (3.7%), and moderate patients (0%) (p<0.001). Peripheral oxygen saturation measured at admission was found to be significantly lower in patients who died. The initial saturations (p=0.008) were found to have independent effects on mortality. CONCLUSION: The results showed that tocilizumab is an effective treatment option for coronavirus disease 2019 disease and reduces mortality, but the key point is timing.

Prognostic value of neutrophile-to-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH) levels for geriatric patients with COVID-19.

AIM: In this study it was aimed to evaluate the prognostic factors for the geriatric patients with confirmed COVID-19 in a tertiary-care hospital at Kastamonu region of Turkey. METHOD: Patients (≥65-year-old) who had PCR positivity for COVID-19 between March 2020 and April 2020 in our center were recorded retrospectively. A p value less than 0.05 was considered significant. Ethical committee approval was given from the Bolu University with decision number 2020/176. RESULTS: There were a total of 100 patients (44% female). In-hospital mortality was recorded as 7%. In univariate analysis for 1 month mortality, diabetes mellitus (p = 0.038), leucocyte count (p = 0.005), neutrophile count (p = 0.02), neutrophile-to-lymphocyte ratio (NLR) (p < 0.001), thrombocyte-to-lymphocyte ratio (TLR) (p = 0.001), C-reactive protein (CRP) (p = 0.002), lactate dehydrogenase (LDH) (p = 0.001), sequential organ failure assessment (SOFA) score (p = 0.001) and qSOFA score (p = 0.002) were found as independent risk factors. On admission, one point increase of NLR (p = 0.014, odds ratio (OR) = 1.371, 95% CI = 1.067-1.761) and one point increase of LDH (p = 0.047, OR = 1.011, 95% CI = 1.001-1.023) were associated with mortality on day 30 according to logistic regression analysis. The cut-off values were found as > 7.8 for NLR (83.33% sensitivity, 97.7% specificity) and > 300 U/L for LDH (100% sensitivity, 79.31% specificity) regarding the prediction of 30-day mortality. CONCLUSION: In order to improve clinical management and identify the geriatric patients with COVID-19 who have high risk for mortality, NLR and LDH levels on admission might be useful prognostic tools.

Evaluation of cases with a preliminary diagnosis of Crimean- Congo hemorrhagic fever and comparison of characteristics in patients admitted to a secondary care hospital in Kastamonu, Turkey.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is an endemic disease in Turkey. The clinical presentation and laboratory findings are not specific especially in cases without hemorrhagic findings. OBJECTIVE: We aimed to evaluate CCHF cases and compare them with non-CCHF cases in terms of their characteristics during admission. METHODS: Cases with a preliminary diagnosis of CCHF at a secondary care hospital in Kastamonu in 2013 were evaluated, retrospectively. Cases testing RNA/IgM positive were considered as CCHF. Cases testing both RNA and IgM negative were considered as non-CCHF. The two groups were then compared in terms of their clinical, laboratory and epidemiological characteristics during admission. RESULTS: A total of 41 cases were tested and CCHF was found in 46.3% of cases. Fatality was 5.3% in CCHF cases. The frequency of tick bites and CK elevation in CCHF cases was significantly higher than non-CCHF cases (p<0.05). There were no significant differences between the two groups regarding other characteristics (p>0.05). CONCLUSIONS: In cases with a preliminary diagnosis of CCHF, especially in cases without a history of tick bite and with normal CK levels during admission, performing tests for the differential diagnosis may be advisable without waiting for the results of tests for CCHF.