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.