Öz
Amaç
Yoğun bakım ünitesinde (YBÜ) tedavi gören Koronavirüs hastalığı-2019 (COVID-19) hastalarında kortikosteroid kullanımının sonuçlarını değerlendirmek ve ikincil enfeksiyon ve mortalite ile ilişkili faktörleri belirlemektir.
Yöntem
Bu retrospektif analiz, 1 Nisan 2020-31 Aralık 2021 tarihleri arasında COVID-19 tedavisi için kabul edilen hastaların verilerini içermektedir. Kortikosteroid alan 114 ve almayan 94 hastanın tıbbi kayıtları kapsamlı bir şekilde incelenerek demografik özellikleri, klinik özellikleri ve laboratuvar sonuçlarına ilişkin bilgiler kaydedildi.
Bulgular
Hastaların 28 günlük mortalite oranı %52,9 (n=110), genel mortalite %61,5 (n=128) ve sekonder enfeksiyon %52,9 (n=110) olarak gerçekleşti. Steroid kullananlarda yoğun bakımda kalış süresi (p=0,001) daha uzun, entübasyon süreleri (p<0,001) daha uzun, pozitif inotropik tedavi ihtiyacı daha yüksek (p<0,001) ve APACHE II skorları daha yüksekti (p=0,014). Genel mortalite steroid alanlarda daha yüksekti (p=0,001), 28 günlük mortalite ise benzerdi (p=0,061). COVID-19 yoğun bakım hastalarında sekonder enfeksiyon sıklığı steroid grubunda anlamlı olarak daha yüksekti (p=0,003). Çok değişkenli lojistik regresyon analizi, yoğun bakımda uzun süreli kalış süresinin [olasılık oranı (OO): 1,174] ve uzun süreli entübasyonun (OO: 1,317) ikincil enfeksiyonlarla bağımsız olarak ilişkili olduğunu gösterdi. Benzer şekilde ileri yaş (OO: 1,079), renal replasman tedavisi ihtiyacı (OO: 7,600), pozitif inotropik tedavi ihtiyacı (OR: 25,627) ve yüksek SOFA skoru (OO: 1,528) bağımsız olarak mortaliteyle ilişkiliydi.
Sonuç: Çalışmanın bulgularına göre, şiddetli COVID-19 olgularında kortikosteroid kullanımı sekonder enfeksiyon veya mortalite riskini artırmıyor gibi görünse de, kortikosteroid kullanım kararı olgunun klinik durumuna göre titizlikle verilmelidir. Ayrıca, COVID-19 hastalarında kortikosteroid kullanımına dair daha geniş kapsamlı ve derinlemesine araştırmalara ihtiyaç duyulmaktadır.
Anahtar Kelimeler: Anahtar kelimeler: Anti-enflamatuar ajanlar, COVID-19, COVID-19 da kullanılan ilaç tedavileri, deksametazon, Koronavirüs enfeksiyonu, metilprednizolon
Kaynakça
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