Method:
This study was done based on the data of the patients hospitalized in the COVID-19 isolation department in Istanbul Bahçelievler State Hospital.
It was performed on 223 patients who were evaluated in the emergency department and then hospitalized between 11 April and 17 May 2020 and whose COVID-19 polymerase chain reaction (PCR) test result was positive. Within the scope of the COVID-19 protocol we conduct in our hospital, patients with cough, sore throat, and respiratory distress are transferred from the emergency triage to the isolation area. Dependent upon the patient’s history, which is taken while a PCR test is administered, hemogram, biochemistry blood tests, and pulmonary computed tomography may be requested. The patient’s history includes questions regarding additional illness and smoking. If the patient has respiratory distress, high fever, bad general condition, accompanying chronic disease, old age, and high computed tomography staging we prepare by referring to other studies4,10, interneed to the isolated service for COVID-19. According to the directive from the Turkish Ministry of Health, we start our treatment with Plaquenil, Azyhtromycin, Oseltamavir, Clexane 0,6, and a high dose Vitamin C. If oxygen saturations are below 90, Favirapir treatment is initiated. On the first day of the patient’s hospitalization, we send routine blood tests for hemogram, full biochemistry, serology, coagulation markers, Troponin, Ferrritin, and D-Dimer levels. If patients have normalized laboratory tests, no fever and no respiratory distress for at least 3 days, and a good general condition, they are discharged with an explanation of isolation rules.
We collected data from 213 patients who were admitted into COVID-19 isolation with positive PCR test results. We recorded various patient values, including white blood cell (Wbc), neutrophil, lymphocyte, platelet, mean platelet volume (MPV), ferritin, D-dimer, troponin-I, c-reactive protein (CRP), magnesium, calcium, creatinine, lactate dehydrogenase (LDH). We also noted age, gender, additional diseases, duration of discharge, whether they live or die, whether they smoke, and their radiological staging.
While inquiring about additional diseases, we use the E-Nabız System that was organized by the Turkish Ministry of Health. This system incorporates a large amount of information, such as what diagnoses patients have had before, the operations they have undergone, and the medications they have been prescribed. For patients who are referred with a pre-diagnosis of COVID-19, smoking-related information is gathered and recorded before the PCR test and confirmed during hospitalization.
In the case of our hospital, chest images were examined by the same radiologist who conducted the earlier tests. A semi-quantitative scoring obtained from CT images was used to determine the severity of COVID-19’s pulmonary involvement. Each lung lobe was scored as 0 (0%), 1 (1–25%), 2 (26–50%), 3 (51–75%), and 4 (76–100%) according to the COVID-19 involvement percentage. The total involvement score (0–20) of all 5 lobes was obtained, and CT evaluation was performed in the lung parenchyma window. A Toshiba Alexion device with 16 detectors, extant in our own hospital, was used. Scoring was performed according to the ground glass opacity appearance of COVID-19, which is the typical lung involvement, and the percentage of consolidations. Of the original 223 patients, those with atypical COVID-19 findings (n = 4), those with lung malignancy (n = 2) and those with atelectasis (n = 4) were excluded from the study, leaving 213 participants.