Evaluation of the Effect of Clinical Characteristics and Intensive Care Treatment Methods on the Mortality of Covid-19 Patients Aged 80 Years and Older

Sibel Oba; Mustafa Altınay; Aysel Salkaya; Hacer Şebnem Türk

Disclosures

BMC Anesthesiol. 2021;21(291) 

In This Article

Methods

This study was approved by the ethics committee of Şişli Hamidiye Etfal Training and Research Hospital with approval number 02.03.2021/1823. All methods were carried out in accordance with Declaration of Helsinki. Data were collected retrospectively about patients 80 years and older treated from Covid-19 in Şişli Hamidiye Etfal Training and Research Hospital ICU between March 1st, 2020, and January 31st, 2021.

We included all patients with age ≥ 80 years who received ICU treatment for Covid-19. We excluded patients who were lacking data.

Şişli Hamidiye Etfal Hospital is one of the largest academic hospitals in Turkey. During the Covid-19 pandemic period, five ICUs with 45 beds in total were rapidly created for the treatment of patients. All patients with nasal cannula or reservoir mask were followed up in another unit in emergency department and the patients in need of intubation or high flow nasal cannula (HFNC) (respiratory rate > 30/min, oxygen saturation < 94%, PaO2/FiO2 < 300) were admitted to ICU. No selection criteria (such as old age or comorbidity) were applied and all Covid-19 cases were managed according to international treatment guidelines. The patients were divided into two groups as survivor and non-survivor. The relevant data was obtained from our hospital's electronic information system and discharge reports of the patients. This data included, age, gender, length of stay, additional diseases (such as Diabetes Mellitus (DM), hypertension (HT), coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD) and other diseases), baseline laboratory values at the induction to ICU (C-reactive protein (CRP), procalcitonin (PCT), Ferritin, D-dimer, Troponin, Lactate, Albumin, Urea, Creatinine, ALT, AST, PaO2, PaCO2, lactate dehydrogenase (LDH), WBC and Lymphocyte. Covid-19 diagnoses were confirmed using polymerase chain reaction testing of nasopharyngeal samples (SARS-CoV2 RT-PCR(+)) and based on the thoracic computed tomography (CT) of the patients. Thoracic CT findings of the patients at the time of admission to the ICU were classified as no-infiltrate, unilateral infiltrates and bilateral infiltrates. The invasive treatment methods investigated were invasive mechanical ventilation (IMV), high flow nasal cannula (HFNC) and/or non-invasive mechanical ventilation (NIMV), hemodiafiltration (HDF), anti-cytokines and plasma therapy.

Statistical Analysis

Statistical analysis of the data was performed through the Windows SPSS15.0 program. Descriptive statistics were given in terms of number and percentage for the categorical variables and in terms of median and interquartile range (IQR) for the numeric variables. The rates in groups were compared via the chi-squared test. Comparisons of two independent groups were made with the Mann Whitney U test, since the numerical variables did not follow the normal distribution condition. The prognosis power of the inflammatory parameters to predict mortality was assessed based on the analysis of the Receiver Operating Characteristic (ROC) curve. Determining factors were investigated with the Logistic Regression Analysis. Statistical alpha significance level was determined at p < 0.05.

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