The aim of the study was to analyze the usefulness of CURB-65 and the pneumonia severity index (PSI) in predicting 30-day mortality in patients with COVID-19, and to identify other factors associated with higher mortality. Methods: A retrospective study was performed in a pandemic hospital in Istanbul, Turkey, which included 681 laboratory-confirmed patients with COVID-19. Data on characteristics, vital signs, and laboratory parameters were recorded from electronic medical records. Receiver operating characteristic analysis was used to quantify the discriminatory abilities of the prognostic scales. Univariate and multivariate logistic regression analyses were performed to identify other predictors of mortality. Results: Higher CRP levels were associated with an increased risk for mortality (OR: 1.015, 95% CI: 1.008-1.021; p < 0.001). The PSI performed significantly better than CURB-65 (AUC: 0.91, 95% CI: 0.88-0.93 vs AUC: 0.88, 95% CI: 0.85-0.90; p = 0.01), and the addition of CRP levels to PSI did not improve the performance of PSI in predicting mortality (AUC: 0.91, 95% CI: 0.88-0.93 vs AUC: 0.92, 95% CI: 0.89-0.94; p = 0.29). Conclusion:In a large group of hospitalized patients with COVID-19, we found that PSI performed better than CURB-65 in predicting mortality. Adding CRP levels to PSI did not improve the 30-day mortality prediction.

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Background The clinical spectrum of COVID-19 has a great variation from asymptomatic infection to acute respiratory distress syndrome and eventually death. The mortality rates vary across the countries probably due to the heterogeneity in study characteristics and patient cohorts as well as treatment strategies. Therefore, we aimed to summarize the clinical characteristics and outcomes of adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia in Istanbul, Turkey. Methods A total of 722 adult patients with laboratory-confirmed COVID-19 pneumonia were analyzed in this single-center retrospective study between March 15 and May 1, 2020. Results A total of 722 laboratory-confirmed patients with COVID-19 pneumonia were included in the study. There were 235 (32.5%) elderly patients and 487 (67.5%) non-elderly patients. The most common comorbidities were hypertension (251 [34.8%]), diabetes mellitus (198 [27.4%]), and ischemic heart disease (66 [9.1%]). The most common symptoms were cough (512 [70.9%]), followed by fever (226 [31.3%]), and shortness of breath (201 [27.8%]). Lymphocytopenia was present in 29.7% of the patients, leukopenia in 12.2%, and elevated CRP in 48.8%. By the end of May 20, 648 (89.7%) patients had been discharged and 60 (8.5%) patients had died. According to our study, while our overall mortality rate was 8.5%, this rate was 14.5% in elderly patients, and the difference was significant. Conclusions This case series provides characteristics and outcomes of sequentially adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia in Turkey.

In this study, laboratorial parameters of hospitalized novel coronavirus (COVID‐19) patients, who were complicated with severe pneumonia, were compared with the findings of cytokine storm developing in macrophage activation syndrome (MAS)/secondary hemophagocytic lymphohistiocytosis (sHLH). Severe pneumonia occurred as a result of cytokine storm in some patients who needed intensive care unit (ICU), and it is aimed to determine the precursive parameters in this situation. Also in this study, the aim is to identify laboratory criteria that predict worsening disease and ICU intensification, as well as the development of cytokine storm. This article comprises a retrospective cohort study of patients admitted to a single institution with COVID‐19 pneumonia. This study includes 150 confirmed COVID‐19 patients with severe pneumonia. When they were considered as severe pneumonia patients, the clinic and laboratory parameters of this group are compared with H‐score criteria. Patients are divided into two subgroups; patients with worsened symptoms who were transferred into tertiary ICU, and patients with stable symptoms followed in the clinic. For the patients with confirmed COVID‐19 infection, after they become complicated with severe pneumonia, lymphocytopenia (55.3%), anemia (12.0%), thrombocytopenia (19.3%), hyperferritinemia (72.5%), hyperfibrinogenemia (63.7%) and elevated lactate dehydrogenase (LDH) (90.8%), aspartate aminotransaminase (AST) (31.3%), alanine aminotransaminase (ALT) (20.7%) are detected. There were no significant changes in other parameters. Blood parameters between the pre‐ICU period and the ICU period (in which their situation had been worsened and acute respiratory distress syndrome [ARDS] was developed) were also compared. In the latter group lymphocyte levels were found significantly reduced ( p = 0.01), and LDH, highly sensitive troponin (hs‐troponin), procalcitonin, and triglyceride levels were significantly increased ( p < 0.05). In addition, there was no change in hemoglobin, leukocyte, platelet, ferritin, and liver function test levels, including patients who developed ARDS, similar to the cytokine storm developed in MAS/sHLH. COVID‐19 pneumonia has similar findings as hyperinflammatory syndromes but does not seem to have typical features as in cytokine storm developed in MAS/sHLH. In the severe patient group who has started to develop ARDS signs, a decrease in lymphocyte level in addition to the elevated LDH, hs‐troponin, procalcitonin, and triglyceride levels can be a predictor in progression to ICU admission and could help in the planning of anti‐cytokine therapy.

Amaç: Arter sertliği damar duvarının viskoelastik özelliklerini yansıtır. Bu çalışmada obez ve obeziteye yatkın genç erişkinlerde aort strain, elastikiyet, sertlik ve sol ventrikül fonksiyonları arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntemler: Katılımcılar VKİ'ye göre obez, fazla kilolu, normal kilolu ve zayıf olarak sınıflandırıldı. 28 zayıf, 84 normal, 89 fazla kilolu ve 22 obez birey vardı. Hastaların fizik muayeneleri, bulguları ve tıbbi öyküleri kaydedildi. Sol ve sağ ventrikül fonksiyonları 2D transtorasik ekokardiyografi ile değerlendirildi. Aortik strain, elastikiyet ve sertlik indeksini içeren aort elastikiyet parametreleri, önceden tanımlanmış formüle göre hesaplandı. Bulgular: Temel klinik ve demografik bulgular, yaş ve ağırlık dışında benzerdi. Ekokardiyografik ölçümlerin karşılaştırılmasında, sol ventrikül sistol sonu ve diyastol sonu çapları, interventriküler septum ve arka duvar diyastol çapları, sol atriyum çapı, sol ventrikül kitle ve kitle indeksi, VKİ'deki artışla uyumlu olarak gruplar arasında anlamlı olarak yüksekti, mitral erken diyastolik dolum hızları, mitral erken ve geç diyastolik dolum hızı oranı ve mitral lateral erken diyastolik gevşeme, VKİ'deki artışın tersine, gruplar arasında anlamlı olarak daha düşüktü (tümü için p < 0.05). Aortik strain, elastikiyet ve sertlik değerleri açısından gruplar arasında istatistiksel olarak anlamlı farklılıklar gözlendi. Aortik sertlik, VKİ'deki artışla uyumlu olarak gruplar arasında anlamlı olarak daha yüksekti, aort strain ve elastikiyeti, VKİ'deki artışa zıt olarak gruplar arasında anlamlı olarak daha düşüktü (tümü için p < 0.05). VKİ, sistolik kan basıncı, nabız basıncı ve miyokardiyal performans indeksi (MPI), aort sertliği indeksini (β) etkileyen bağımsız değişkenler olarak bulundu. Sonuç: Gelecekteki kardiyovasküler hastalık riskini belirlemede prognostik bir değeri olabilecek aort sertliği indeksi (β), obez ve obeziteye yatkın genç erişkinlerde artma eğilimindedir ve VKİ, sistolik kan basıncı ve sol ventrikül MPI ile korele olduğu gözlenmiştir.