key: cord-0711750-1roumsdf authors: Turan, Onur; Mirici, Arzu; Duru Akçalı, Serap; Turan, Pakize Ayşe; Batum, Özgür; Şengül, Aysun; Ekici Ünsal, Zühal; Işık Kabakoğlu, Nalan; Ogan, Nalan; Torun, Şerife; Ak, Güntülü; Akçay, Şule; Kömürcüoğlu, Berna; Şen, Nazan; Mutlu, Pınar; Yilmaz, Ülkü title: Characteristics of hospitalised COVID‐19 patients and parameters associated with severe pneumonia date: 2021-09-15 journal: Int J Clin Pract DOI: 10.1111/ijcp.14786 sha: 53853a53e62c3889393bd6265224295423962fad doc_id: 711750 cord_uid: 1roumsdf BACKGROUND: After the first case of coronavirus disease 2019 (COVID‐19) was reported in China in December 2019, it caused a global pandemic, including Turkey. OBJECTIVES: The aim of this study was to analyse the characteristics of hospitalised COVID‐19 patients and assess the parameters related to severe pneumonia. METHODS: Included in the study were hospitalised COVID‐19 patients with positive naso‐oropharyngeal swabs. Patients’ demographics, admission symptoms, laboratory and radiological findings were recorded retrospectively. RESULTS: Of 1013 patients, 583 were males (57.6%) and 430 were females (42.4%), with a mean age of 53.7 ± 17.9. More than half of the patients had at least one comorbidities, the most common of which were hypertension and diabetes mellitus. Cough (59.8%), fatigue (49.5%) and fever (41.2%) were the most common presenting symptoms. Of the hospitalised COVID‐19 patients, 84.9% had pneumonia and 83.5% had typical radiological COVID‐19 appearances (94.5%: ground‐glass areas). The most common laboratory findings were high C‐reactive protein (CRP) (73.6%) and lactate dehydrogenase (LDH) (46.2%) levels, as well as lymphopenia (30.1%). Severe pneumonia was present in 28.1% of COVID‐19 patients. Multivariate logistic regression analysis indicated that advanced age, hypotension, anaemia and elevated CRP and LDH serum levels were independent risk factors for the severity of COVID‐19 pneumonia (P = .011, .006, .017, .003 and .001, respectively). CONCLUSION: This study, as one of the first multicentre studies about characteristics of COVID‐19 in Turkey, may guide about disease‐related parameters and severity of pneumonia. Age, blood pressure, complete blood count and routine biochemical tests (including CRP and LDH) would appear to be important parameters for the evaluation of the severity of COVID‐19 pneumonia. By the end of 2019, a new type of coronavirus-SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2)-was isolated as a factor in cases of pneumonia with an unknown aetiology in China. 1 The disease was first seen in Turkey in March 2020, 2 and since then, more than 380,000 people have been infected, and over 10 000 have died from 'Coronavirus Disease 2019' in our country. 1 The clinical diagnoses of COVID-19 are based on clinical manifestations, molecular examinations, thoracic imaging and blood tests. 3 The molecular diagnostic technique, based on a viral genetic real-time polymerase chain reaction (RT-PCR) assay, has been the most common and only direct method of SARS-CoV-2 detection for the diagnosis of COVID- 19. 4 The clinical spectrum of COVID-19 is wide, ranging from asymptomatic patients with mild forms of the disease to severe pneumonia requiring admission to the intensive care unit (ICU). 5 The common initial symptoms include fever, cough and shortness of breath, although symptoms such as weakness, fatigue, myalgia and loss of taste and/or smell have also been reported. 6 Radiological examinations play an important role in the early detection and diagnosis of COVID-19 pneumonia. Chest radiography is not sufficiently sensitive as a radiological approach in the early stage of infection, so thorax computed tomography (CT) is generally applied to assist in the diagnosis of COVID-19 pneumonia. 7 Laboratory parameters have been used both for diagnostic purposes and for the prediction of prognosis in COVID-19. The routine tests requested for COVID-19 patients include complete blood count (CBC), coagulation cascade (including PT, aPTT and D-dimers) parameters, and inflammation-related parameters such as CRP, ferritin and procalcitonin. 8 Since COVID-19 may also impair such organs as the heart, liver and kidneys, 9 the use of biochemical factors to assess the functional activity of these vital organs is important for clinicians. The aim of this study was to determine the epidemiologic and the clinical, radiological and laboratory features of hospitalised COVID-19 patients and to assess the parameters related to severe pneumonia. This multicentre, retrospective nationwide cohort study of COVID-19 patients admitted to Turkish hospitals included patients with positive naso-oropharyngeal swabs taken using real-time PCR (RT-PCR) assay kits in 10 different centres between March and September 2020. Ethics committee approval for the study was obtained from the Ethics Committee of the İzmir Katip Çelebi University Atatürk Training and Research Hospital, and permission for the study was obtained also from the Ministry of Health of the Republic of Turkey. The requirement for informed consent was waived due to the retrospective design of the study. All of the enrolled patients were over the age of 18 years, and were confirmed as SARS-CoV-2 RNA positive based on oronasopharyngeal swab specimens obtained using real-time reversetranscriptase polymerase chain reaction (RT-PCR) assays. The patients' demographics, risk factors for COVID-19, comorbid diseases, vital signs and symptoms at admission, as well as their laboratory and radiological findings, were accessed from the digital medical records of the hospitals participating in the study. COVID-19 pneumonia was considered to be present in cases with an official thorax CT report confirming the diagnosis. The radiological findings of pneumonia in a thorax CT were evaluated according to the COVID-19 pneumonia imaging classification laid out in the Radiological Society of North America Expert Consensus Statement. 10 The patients were subsequently divided into four analysis indicated that advanced age, hypotension, anaemia and elevated CRP and LDH serum levels were independent risk factors for the severity of COVID-19 pneumonia (P = .011, .006, .017, .003 and .001, respectively). This study, as one of the first multicentre studies about characteristics of COVID-19 in Turkey, may guide about disease-related parameters and severity of pneumonia. Age, blood pressure, complete blood count and routine biochemical tests (including CRP and LDH) would appear to be important parameters for the evaluation of the severity of COVID-19 pneumonia. • COVID-19 may be a serious and fatal disease, especially when it is accompanied by pneumonia. • Age, blood pressure, complete blood count and routine biochemical tests (including CRP and LDH) would appear to be important parameters for the evaluation of the severity of COVID-19 pneumonia. categories as negative for pneumonia, typical appearance, indeterminate appearance and atypical appearance. The laboratory data in this study include routine blood tests, such as complete blood count, biochemistry tests, blood clotting tests and a number of infection-related parameters that were assessed at the time of admission. The initial values of these laboratory indexes were collected for analysis in this study. The COVID-19 patients were divided into two main groups, being those with severe or non-severe (mild) pneumonia. Severe pneumonia was defined as 'the presence of dyspnoea, respiratory frequency ≥30/min and/or blood oxygen saturation ≤90% (PaO 2 /FiO 2 ratio Tachycardia is defined as ≥100 beats/min, tachypnoea as >20 breaths/min at presentation, hypotension as a decrease in systolic blood pressure to less than 90 mm Hg or diastolic blood pressure to less than 40 mm Hg. Neutropenia is defined as an absolute neutrophil count below 2 × 10 9 /L, and lymphopenia as blood lymphocytes lower than 1 × 10 9 /L. Thrombocytopenia is defined as a platelet count below 150 × 10 9 /L. The normal haemoglobin (Hb) level for males is 14-18, and 12-16 g/dL for females. The lower Hb level is Statistical analyses were performed using the SPSS Version 16.0 (Chicago, SPSS Inc) software package. Baseline characteristics, including demographic data, the presence of symptoms and radiological and laboratory findings were summarised using descriptive statistics. The continuity correction χ 2 test and a Fisher's exact test were used for the comparison of the frequency rates of the categorical variables of the severe and non-severe COVID-19 patients. The Pearson correlation was used to assess the strength of the linear relationship between two variables. The demographics and initial symptoms, and radiological and laboratory findings with significant differences between the two groups were assessed with a multivariate logistic regression analysis (using a stepwise backward LR method) to explore the risk factors associated with the disease severity of COVID-19. A paired sample t-test was used to compare the means of the groups. A P-value <.05 was considered as statistically significant. Of the 1013 patients included in the study, 583 were males (57.6%) and 430 were females (42.4%), with the mean age of 53.7 ± 17.9. The demographics and general information of the COVID-19 patients are presented in Table 1 . More than half (524%-51.7%) of the patients had at least one comorbidity, the most prevalent of which were 54.2% hypertension (HT), 24 Of the total, 788 patients (77.8%) recorded a positive RT-PCR nasopharyngeal swab in the first specimen. The COVID-19 diagnoses of the remaining 225 patients were confirmed by second or third swab tests. The median duration of symptoms at admission was 4.4 days. Upon admission, most patients had experienced cough (59.8%). Fatigue (49.5%) and fever (41.2%) were the other most common presenting symptoms, with less frequent symptoms being myalgia (34%), dyspnoea (28%), sore throat (7.9%), anosmia (7.3%) and headache With respect to vital sign abnormalities, tachycardia was determined in 9.6%, hypotension in 4.3% and tachypnoea in 18.6% of the patients. The mean oxygen saturation at the time of admission was 92.9 ± 4.6%. There was hypoxemia in 13.8% of the patients accord- ing to the results of both a pulse oximetry and arterial blood gas analysis at the time of hospital admission. The most common abnormal laboratory findings were high-level CRP (73.6%) and LDH (46.2%), and the presence of lymphopenia (30.1%). Severe pneumonia was present in 242 of the 860 (28.1%) patients with COVID-19 pneumonia. pneumonia (all P < .001). Table 2 shows the clinical features, symptoms, vital signs and pneumonia severity of the COVID-19 patients. In patients with severe COVID pneumonia, the mean lympho- There were statistically more patients with bilateral, multifocal and peripheral involvement in severe COVID-19 pneumonia group (all P < .001). Table 3 presents the numerous differences in the laboratory findings of the severe and non-severe COVID-19 pneumonia cases. There were statistically more patients with bilateral and multifocal involvement in the group with severe COVID-19 pneumonia (all P < .001) and hypoxemia (P = .006 and .002, respectively). Peripheral involvement in thorax CT was significantly more common in nonsevere pneumonia (P = .004) and normoxemic patients (P < .001). The relationship between severity of pneumonia (including hypoxemia as a separate parameter) and radiological findings is described in Table 4 . A multivariate logistic regression analysis indicated that advanced age, anaemia, hypotension and elevated CRP and LDH levels were independent risk factors for the severity of pneumonia in COVID-19 patients (P = .011, .006, .017, .003 and .001, respectively) ( Table 5 ). Similar to other recent studies, the most common symptoms at the onset of illness were dry cough, fatigue and fever in our COVID-19 patients. 15, 16 Typical pneumonia, which develops secondary to bacterial microorganisms, usually manifests with a sudden onset of fever and a productive cough. 17 As sputum production is rarely seen in COVID-19 (<1%), it may be helpful in differentiating between bacterial and COVID-19-related pneumonia. were present in 16% of the patients in this study. GI symptoms have been described in 4%-11% of cases in previous studies, 18 The data that support the findings of this study are available on request from the corresponding author. 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