The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients
Nurdan Kokturk, Cenk Babayigit, Seval Kul, Pelin Duru Cetinkaya, Sibel Atis Nayci, Serap Argun Baris, Oguz Karcioglu, Pinar Aysert, Ilim Irmak, Aycan Akbas Yuksel, Yonca Sekibag, Oya Baydar Toprak, Emel Azak, Sait Mulamahmutoglu, Caglar Cuhadaroglu, Aslihan Demirel, Bugra Kerget, Burcu Baran Ketencioglu, Hasan Selcuk Ozger, Gulcihan Ozkan, Zeynep Ture, Begum Ergan, Vildan Avkan Oguz, Oguz Kilinc, Merve Ercelik, Tansu Ulukavak Ciftci, Ozlem Alici, Esra Nurlu Temel, Ozlem Ataoglu, Asena Aydin, Dilek Cetiner Bahcetepe, Yusuf Taha Gullu, Fusun Fakili, Figen Deveci, Neslihan Kose, Muge Meltem Tor, Gulsah Gunluoglu, Sedat Altin, Teyfik Turgut, Tibel Tuna, Onder Ozturk, Oner Dikensoy, Pinar Yildiz Gulhan, Ilknur Basyigit, Hasim Boyaci, I Kivilcim Oguzulgen, Sermin Borekci, Bilun Gemicioglu, Firat Bayraktar, Osman Elbek, Ismail Hanta, Hacer Kuzu Okur, Gulseren Sagcan, Oguz Uzun, Metin Akgun, Goksel Altinisik, Berna Dursun, Ebru Cakir Edis, Erkmen Gulhan, Fusun Oner Eyuboglu, Okkes Gultekin, Yavuz Havlucu, Metin Ozkan, Aysin Sakar Coskun, Abdullah Sayiner, Ali Fuat Kalyoncu, Oya Itil, Hasan Bayram
Respiratory Medicine, doi:10.1016/j.rmed.2021.106433
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;). 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.
Author's contributions NK, HB, OI, CB, FOE, AS, ECE, BD, and AFK designed the study; NK, CB, PDC, SAB, OK, PA, II, AAY, YS, OBT, EA, SM, CC, AD, BK, BBK, HSO, GO, ZTY, BE, VAO, OK, ME, TUC, OA, ENT, OA, AA, DCB, YTG, FF, FD, NK, MMT, GG, SA, TT, TT, OO, OD, PYG, IB, HB, IKO, SB, BG, FB, OE, IH, HKO, GS, OU, and MA collected the data; SK and SAN analyzed the data; NK, CB, SK, SAN searched the literature and wrote the manuscript; NK, SAB, PDC, BG, OG, EM, MMT, GA and SAB edited and revised manuscript according to journal's instructions; NK, FOE, AS, MMT, OE, BG, YH, ASC and HB edited and controlled the final version of the manuscript. All of the authors approved the final version of the manuscript.
Disclaimers The views expressed in this article do not communicate an official position of the Turkish Thoracic Society.
Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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