Background It is thought vaccines allowed for emergency use significantly reduce hospitalizations and emergency room visits. It is a matter of curiosity how many of the patients who come to the emergency department (ED) are vaccinated. We aimed to examine the characteristics of ED patients needing hospitalizations related to moderate and severe COVID-19 by vaccination status. Methods A retrospective study of 559 rRT-PCR-confirmed SARS-CoV-2 infection cases with moderate or severe COVID-19 needing hospitalization was performed in August 2021. Univariate and multivariate logistic regression analyses were performed for factors associated with mortality. Results The mean age of the patients was 60.8 ± 18.1 years old, and 54.2% ( n = 303) of the patients were women. The most common comorbidities were hypertension (37.2%), diabetes mellitus (31.1%) and chronic obstructive pulmonary disease (13.8%), respectively. The number of patients with alpha variant was 399 (71.4%), and delta variant was 83 (14.8%). Fifty point 6% ( n = 283) of the patients were fully vaccinated. The total number of patients who died in the study was 114 (20.4%), and the number of patients hospitalized in the intensive care unit was 168 (30.1%). The day between the last dose of vaccine and hospitalization was 117 ± 45.9 days. In multivariate logistic regression analysis: age (odds ratio (OR), 1.05; 95% confidence intervals (95% CI) 1.03–1.08- year increase), male gender (OR, 1.8; 95% CI, 1.1–2.9), presence of at least one comorbid disease (OR, 2; 95% CI, 1.1–3.7) and partial (OR, 0.24;95% CI, 0.09–0.6) and fully vaccinated status (OR, 0.1; 95% CI, 0.05–0.18) were associated with mortality among COVID-19 patients. Conclusions In this study, age older than 65, unvaccinated, and comorbidities had significantly higher mortality. In multivariate regression analyses, age, vaccination status, comorbidities and the male gender were associated with mortality. Our study did not evaluate the vaccine efficacy but, a lower mortality rate was observed in those fully vaccinated with CoronaVac and Pfizer–BioNTech. Additionally, Alpha, Delta and other variants had the same mortality rates.
Amaç: Bu çalışmada COVID-19 hastalarına bakan infekte sağlık çalışanlarının temas risk durumlarının belirlenmesi ve hastalık durumlarının değerlendirilmesi amaçlanmıştır. Yöntemler: COVID-19 geçiren sağlık çalışanları retrospektif olarak değerlendirilmiştir. Hastalarla olan yakın temasları, kişisel koruyucu ekipman kullanımlarına göre yüksek, orta, düşük riskli veya risksiz temas olarak sınıflandırılmış ve bulaşma düzeyleri değerlendirilmiştir. İnfekte olduktan sonra gelişen semptomlar ve hastalığın ağırlığı belirlenmiştir. Bulgular: Çalışma süresi boyunca toplam 82 sağlık çalışanı infekte olmuştur ve sadece %2'sinde yüksek riskli temas vardı. Risksiz temas ise %71'inde saptanmıştır. Başlıca bulaşma kaynağı olarak ise toplum/aile kaynaklı bulaşma saptanmıştır. İnfekte sağlık çalışanlarının %82'sinde en az bir semptom gelişmiştir. Ateş (%65) ve kuru öksürük (%54) en sık görülen semptomlardı. Klinik ağırlıklarına göre %66'sı, hastalığı hafif şekilde atlatmıştı. Yalnızca bir sağlık çalışanı ağır hastalık tablosu gösterdi. COVID-19 saptanan sağlık çalışanlarının tamamı iyileşerek taburcu edilmiştir. Sonuçlar: Sağlık çalışanlarına COVID-19 bulaşması riski artmıştır. Uygun kişisel koruyucu ekipman kullanımının yanında, sosyal ortamlarda da maske ve sosyal mesafe kurallarına uyulmalıdır.
Background Respiratory failure and death are the leading causes of severe Coronavirus disease 2019 (COVID‐19). Hyper‐inflammation and cytokine storm cause lung damage. This study aimed to compare the low‐dose and high‐dose effects of tocilizumab, an IL‐6 receptor antagonist. Method Patients with severe pneumonia and hyper‐inflammation signs because of COVID‐19 were included in this retrospective study. Patients receiving tocilizumab <200 mg intravenously were classified as the low‐dose group, and receiving ≥200 mg as the high‐dose group, and those not treated with tocilizumab as the control group. Demographic and clinical data of patients who died and survived in both low‐high dose and control patients were compared. According to symptom day and radiological infiltration, patients with tocilizumab were also evaluated in two groups as early and late periods at tocilizumab administration time. Results A total of 160 patients were included in the study; 70 were treated with a low dose and 50 with high‐dose tocilizumab. Forty patients were in the control group. Age, comorbidity and clinical features were similar in the control, low‐dose tocilizumab and high‐dose tocilizumab groups. The mortality rate (12.9%, 30.0%, 37.5, P = .008) was less in the low‐dose tocilizumab group. The secondary infection rate was higher in the high‐dose group than in the low‐dose tocilizumab and control groups (44.0%, 10.0%, 10.0%, P < .001). Distinguishing between those patients who died and survived, age (OR: 1.1589, P < .001), higher APACHE II scores (OR: 1.225, P = .001) and needs for non‐invasive mechanical ventilation (OR: 14.469, P < .001) were the most critical risk factors. Low‐dose tocilizumab was associated with a lower mortality rate (OR: 0.244, P = .012). Conclusion The use of tocilizumab at a low dose is associated with lower secondary infections and mortality.
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