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The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients - 19/05/21

Doi : 10.1016/j.rmed.2021.106433 
Nurdan Kokturk a, , Cenk Babayigit b , Seval Kul c , Pelin Duru Cetinkaya d , Sibel Atis Nayci e , Serap Argun Baris f , Oguz Karcioglu g , Pinar Aysert h , Ilim Irmak i , Aycan Akbas Yuksel j , Yonca Sekibag k , Oya Baydar Toprak l , Emel Azak m , Sait Mulamahmutoglu k , Caglar Cuhadaroglu n , Aslihan Demirel o , Bugra Kerget p , Burcu Baran Ketencioglu q , Hasan Selcuk Ozger h , Gulcihan Ozkan r, s , Zeynep Ture t , Begum Ergan u , Vildan Avkan Oguz v , Oguz Kilinc u , Merve Ercelik w , Tansu Ulukavak Ciftci a , Ozlem Alici x , Esra Nurlu Temel y , Ozlem Ataoglu w , Asena Aydin z , Dilek Cetiner Bahcetepe z , Yusuf Taha Gullu aa , Fusun Fakili ab , Figen Deveci ac , Neslihan Kose ad , Muge Meltem Tor ae , Gulsah Gunluoglu af , Sedat Altin af , Teyfik Turgut ac , Tibel Tuna aa , Onder Ozturk ag , Oner Dikensoy ah , Pinar Yildiz Gulhan w , Ilknur Basyigit f , Hasim Boyaci f , I. Kivilcim Oguzulgen a , Sermin Borekci k , Bilun Gemicioglu k , Firat Bayraktar ai , Osman Elbek aj , Ismail Hanta l , Hacer Kuzu Okur n , Gulseren Sagcan n , Oguz Uzun aa , Metin Akgun p , Goksel Altinisik ak , Berna Dursun al , Ebru Cakir Edis am , Erkmen Gulhan an , Fusun Oner Eyuboglu ao , Okkes Gultekin ap , Yavuz Havlucu ap , Metin Ozkan al , Aysin Sakar Coskun ap , Abdullah Sayiner aq , Ali Fuat Kalyoncu i , Oya Itil u , Hasan Bayram ar
a Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey 
b Department of Pulmonary Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey 
c Department of Biostatistics, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey 
d Department of Pulmonary Medicine, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey 
e Department of Pulmonary Medicine, Faculty of Medicine, Mersin University, Mersin, Turkey 
f Department of Pulmonary Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey 
g Department of Pulmonary Medicine, Halil Sıvgın Cubuk State Hospital, Ankara, Turkey 
h Department of Infectious Disease, Faculty of Medicine, Gazi University, Ankara, Turkey 
i Department of Pulmonary Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey 
j Department of Pulmonary Medicine, Faculty of Medicine, Ufuk University, Ankara, Turkey 
k Department of Pulmonary Disease, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey 
l Department of Pulmonary Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey 
m Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli Turkey 
n Department of Pulmonary Medicine, Altunizade Acibadem Hospital, Istanbul, Turkey 
o Department of Infectious Disease, Kadikoy Florence Nightingale Hospital, Istanbul, Turkey 
p Department of Pulmonary Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey 
q Department of Pulmonary Medicine, Faculty of Medicine, Erciyes University, Kayseri, Turkey 
r Department of Pulmonary Medicine, Maslak Acibadem Hospital, Istanbul, Turkey 
s Operating Room Services Department, Nisantasi University, Vocational School, Istanbul, Turkey 
t Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey 
u Department of Pulmonary Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey 
v Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey 
w Department of Pulmonary Medicine, Faculty of Medicine, Duzce University, Duzce, Turkey 
x Department of Infectious Disease, Faculty of Medicine, Turkiye Gazetesi Private Hospital, Istanbul, Turkey 
y Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey 
z Department of Pulmonary Medicine, Kestel State Hospital, Bursa, Turkey 
aa Department of Pulmonary Medicine, Faculty of Medicine, On Dokuz Mayis University, Samsun, Turkey 
ab Department of Pulmonary Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey 
ac Department of Pulmonary Medicine, Faculty of Medicine, Firat University, Elazig, Turkey 
ad Department of Pulmonary Medicine, Bilecik Training and Research Hospital, Bilecik, Turkey 
ae Department of Pulmonary Medicine, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey 
af Department of Pulmonary Medicine, University of Health Science, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey 
ag Department of Pulmonary Medicine, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey 
ah Department of Pulmonary Medicine, Faculty of Medicine, Taksim, Acibadem University, Istanbul, Turkey 
ai Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey 
aj Department of Pulmonary Medicine, Kadikoy Florence Nightingale Hospital, Istanbul, Turkey 
ak Department of Pulmonary Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey 
al Department of Pulmonary Medicine, Ankara Memorial Hospital, Ankara, Turkey 
am Department of Pulmonary Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey 
an Department of Thoracic Surgery, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey 
ao Department of Pulmonary Medicine, Baskent University, School of Medicine, Ankara, Turkey 
ap Department of Pulmonary Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey 
aq Department of Pulmonary Medicine, Faculty of Medicine, Ege University, Izmir, Turkey 
ar Department of Pulmonary Medicine, Koc University Research Center for Translational Medicine (KUTTAM), Koc University School of Medicine, Istanbul, Turkey 

Corresponding author. Gazi University, School of Medicine, Department of Pulmonary Medicine, Ankara, Turkey.Gazi UniversitySchool of MedicineDepartment of Pulmonary MedicineAnkaraTurkey

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Abstract

The COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5–5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6–23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored.

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Highlights

The in-hospital mortality was 4.5% in COVID-19 patients of varying severity.
Interstitial lung disease was a strong independent risk factor for mortality in COVID-19.
Follow-up procalcitonin level showed the strongest association with mortality.

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Keywords : COVID-19 deaths, In-hospital mortality, Risk factors


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Article 106433- juillet 2021 Retour au numéro
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