A comparison of computerized tomography findings of COVID-19 infection by gender and age groups.

OBJECTIVE: To compare the computed tomography (CT) imaging findings of coronavirus disease 2019 (COVID-19) by gender and age groups. METHODS: The patients with COVID-19 (n=1,024) were divided into nine age groups (0-9 years, 10-19 years, 20-29 years, 30-39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, and 80 years and above). The CT findings were retrospectively analyzed according to the age groups and gender. RESULTS: Under 20 years of age, except for the ground-glass opacity and consolidation, no other finding was observed. Airway changes and crazy-paving pattern were more common over 80 years. While the tree-in-bud pattern was more common in the 20-29 age group than in other age groups, the halo sign was mostly seen at the age of 30-39 years. Unlike other groups, the thin reticular pattern was more common in patients aged 60-79 years. When the findings were compared by gender, the rates of centrilobular nodules (p=0.006), airway changes (p=0.004), and tree-in-bud pattern (p=0.050) were significantly higher in males than in females. CONCLUSION: The chest CT findings of COVID-19 show significant changes according to age and gender. The findings that are more common in elderly and male patients should be carefully evaluated in terms of the prognosis of the disease.

Correlation between venous blood gas indices and radiological involvements of COVID-19 patients at first admission to emergency department.

BACKGROUND: The purpose of this study was to investigate the relation between venous blood gas and chest computerized tomography findings and the clinical conditions of COVID-19 pneumonia. METHODS: A total of 309 patients admitted to the emergency department and subsequently confirmed COVID-19 cases was examined. Patients with pneumonia symptoms, chest computerized tomography scan, venous blood gas findings, and confirmed COVID-19 on reverse transcription-polymerase chain reaction (PCR) were consecutively enrolled. Multiple linear regression was used to predict computerized tomography and blood gas findings by clinical/laboratory data. RESULTS: The median age of patients was 51 (interquartile range 39-66), and 51.5% were male. The mortality rate at the end of follow-up was 18.8%. With respect to survival status of patients pCO2 and HCO3 levels and total computerized tomography score values were found to be higher in the surviving patients (p<0.001 and p=0.003, respectively), whereas pH and lactate levels were higher in patients who died (p=0.022 and p=0.001, respectively). With logistic regression analysis, total tomography score was found to be significantly effective on mortality (p<0.001). The diffuse and random involvement of the lungs had a significant effect on mortality (p<0.001, 95%CI 3.853-38.769, OR 12.222 and p=0.027; 95%CI 1.155-11.640, OR 3.667, respectively). With linear regression analysis, the effect of pH and lactate results were found to have a positive effect on total tomography score (p=0.003 and p<0.001, respectively), whereas pCO2 was found to have a negative effect (p=0.029). CONCLUSION: There was correlation between venous blood gas indices and radiologic scores in COVID-19 patients. Venous blood gas taken in emergency department can be a fast, applicable, minor-invasive, and complementary test in terms of diagnosing COVID-19 pneumonia and predicting the prognosis of disease.

Correlation between venous blood gas indices and radiological involvements of COVID-19 patients at first admission to emergency department

SUMMARY The purpose of this study was to investigate the relation between venous blood gas and chest computerized tomography findings and the clinical conditions of COVID-19 pneumonia. METHODS: A total of 309 patients admitted to the emergency department and subsequently confirmed COVID-19 cases was examined. Patients with pneumonia symptoms, chest computerized tomography scan, venous blood gas findings, and confirmed COVID-19 on reverse transcription-polymerase chain reaction (PCR) were consecutively enrolled. Multiple linear regression was used to predict computerized tomography and blood gas findings by clinical/laboratory data. RESULTS: The median age of patients was 51 (interquartile range 39-66), and 51.5% were male. The mortality rate at the end of follow-up was 18.8%. With respect to survival status of patients pCO2 and HCO3 levels and total computerized tomography score values were found to be higher in the surviving patients (p<0.001 and p=0.003, respectively), whereas pH and lactate levels were higher in patients who died (p=0.022 and p=0.001, respectively). With logistic regression analysis, total tomography score was found to be significantly effective on mortality (p<0.001). The diffuse and random involvement of the lungs had a significant effect on mortality (p<0.001, 95%CI 3.853-38.769, OR 12.222 and p=0.027; 95%CI 1.155-11.640, OR 3.667, respectively). With linear regression analysis, the effect of pH and lactate results were found to have a positive effect on total tomography score (p=0.003 and p<0.001, respectively), whereas pCO2 was found to have a negative effect (p=0.029). CONCLUSION: There was correlation between venous blood gas indices and radiologic scores in COVID-19 patients. Venous blood gas taken in emergency department can be a fast, applicable, minor-invasive, and complementary test in terms of diagnosing COVID-19 pneumonia and predicting the prognosis of disease.

Evaluation of re-hospitalized COVID-19 patients in a hospital.

PURPOSE: This study intends to investigate the reasons for re-hospitalization, complaints, and prognoses of COVID-19 patients after being discharged. METHODS: COVID-19 patients who were re-hospitalized at the Sakarya University Training and Research Hospital were examined. Reverse transcriptase-polymerase chain reaction (RT-PCR), tomography and laboratory results, demographic characteristics, and prognostic results were recorded retrospectively. RESULTS: A total of 60 patients, including 26 males (43.3%) and 34 females (56.7%), with repeated admissions to the hospital for COVID-19 symptoms, were included in the study with a mean age of 56.9 (± 22.5) (median value = 61, age range = 3-88). The number of days of the second hospitalization was statistically significantly higher (p < 0.05). Patient age and number of days of hospitalization were strongly positively correlated (p < 0.01). A total of 11 patients (18%) had negative results in their first RT-PCR and subsequently tested positive in their second hospitalization. In addition, 10 (17.5%) of the patients who underwent thoracic tomography had unilateral involvement, 34 (59.6%) had bilateral involvement, and 13 (22.8%) had no significant results. Note that 4 (6.6%) of the patients re-hospitalized died in the hospital, while 56 (93.4%) were discharged once more. All of the four patients that died were female with a mean age of 81.5 years. CONCLUSION: Particularly patients with advanced age and comorbidities should be examined more carefully when discharged; if their complaints are repeated, they should be advised to quickly contact the emergency service.

Evaluation of re-hospitalized COVID-19 patients in a hospital

SUMMARY PURPOSE: This study intends to investigate the reasons for re-hospitalization, complaints, and prognoses of COVID-19 patients after being discharged. METHODS: COVID-19 patients who were re-hospitalized at the Sakarya University Training and Research Hospital were examined. Reverse transcriptase-polymerase chain reaction (RT-PCR), tomography and laboratory results, demographic characteristics, and prognostic results were recorded retrospectively. RESULTS: A total of 60 patients, including 26 males (43.3%) and 34 females (56.7%), with repeated admissions to the hospital for COVID-19 symptoms, were included in the study with a mean age of 56.9 (± 22.5) (median value = 61, age range = 3-88). The number of days of the second hospitalization was statistically significantly higher (p < 0.05). Patient age and number of days of hospitalization were strongly positively correlated (p < 0.01). A total of 11 patients (18%) had negative results in their first RT-PCR and subsequently tested positive in their second hospitalization. In addition, 10 (17.5%) of the patients who underwent thoracic tomography had unilateral involvement, 34 (59.6%) had bilateral involvement, and 13 (22.8%) had no significant results. Note that 4 (6.6%) of the patients re-hospitalized died in the hospital, while 56 (93.4%) were discharged once more. All of the four patients that died were female with a mean age of 81.5 years. CONCLUSION: Particularly patients with advanced age and comorbidities should be examined more carefully when discharged; if their complaints are repeated, they should be advised to quickly contact the emergency service.

RESUMO OBJETIVO: Este estudo pretende investigar as causas para re-hospitalizações, as reclamações e os prognósticos de pacientes com COVID-19 após a alta hospitalar. MÉTODOS: Pacientes com COVID-19 internados que foram re-hospitalizados no Sakarya University Training and Research Hospital foram examinados. Os resultados da reação em cadeia de polimerase precedida de transcrição reversa (RT-PCR), tomografia e dos exames laboratoriais, as características demográficas e os resultados prognósticos foram registrados retrospectivamente. RESULTADOS: Um total de 60 pacientes, 26 do sexo masculino (43,3%) e 34 do sexo feminino (56,7%), com internações repetidas devido a sintomas de COVID-19 foram incluídos no estudo, com uma idade média de 56,9 (± 22,5) (mediana = 61, faixa etária = 3-88). O número de dias da segunda internação foi estatisticamente significativamente maior (p < 0,05). A idade do paciente e o número de dias de internação apresentaram uma forte correlação positiva (p < 0,01). Um total de 11 pacientes (18%) apresentaram resultados negativos no primeiro RT-PCR e posteriormente tiveram resultados positivos na segunda internação. Além disso, 10 (17,5%) dos pacientes submetidos a tomografia de tórax apresentaram envolvimento unilateral, 34 (59,6%) bilateral, e 13 (22,8%) não apresentaram resultados significativos. Nota-se que 4 (6,6%) dos pacientes re-hospitalizados morreram no hospital, enquanto 56 (93,4%) receberam alta mais uma vez. Todos os quatro pacientes que morreram eram do sexo feminino, com idade média de 81,5 anos. CONCLUSÃO: Principalmente pacientes com idade avançada e comorbidades devem ser examinados com mais cuidado no momento da alta hospitalar; caso suas queixas se repitam, eles devem ser aconselhados a contatar o serviço de emergência o quanto antes.

Can COVID-19 Mortality be Predicted in the Emergency Room?

OBJECTIVE: To investigate the association ​of white blood cell (WBC) counts, neutrophil, platelets, lymphocyte counts, C-reactive protein (CRP), neutrophil / lymphocyte ratio (NLR), derived NLR ratio (d-NLR), and platelet / lymphocyte ratio (PLR) at the time of first admission for mortality caused by COVID-19. STUDY DESIGN:  Descritive, analytical study. PLACE AND DURATION OF STUDY: Department of Emergency Medicine, Sakarya University Training and Research Hospital, Turkey from  March 2020 to  May 2020. METHODOLOGY: One hundred and sixty-nine patients with the diagnosis of Covid-19 were retrospectively reviewed. Patients were divided into two groups as survivors and non-survivors. Inclusion criteria were age ≥18 years, RT-PCR test positivity, hospitalisation. Patients with missing data were excluded. Data regarding age, gender, WBC counts, neutrophil, platelets, and lymphocyte, CRP, NLR, d-NLR, PLR and comorbid conditions were analysed for mortality. All tests were done with a two-sided significance of 5%. For each endpoint, the absolute and relative effects and their corresponding 95% confidence interval  were calculated. RESULTS: There was a statistically significant association between neutrophil, lymphocyte, CRP, NLR, d-NLR and PLR values (p=0.005, p<0.001, p<0.001, p<0.001, p<0.001, and p<0.001, respectively) with mortality status of the patients. The cutoff values calculated by this analysis were 67.50 years for age, 5.12 K / µl for neutrophil, 1.12 K / µl for lymphocyte, 67.78 mg / dl for CRP, 3.9 for NLR, 2.55 for d-NLR, and 148.85 for PLR. CONCLUSION: Altered neutrophil and lymphocyte counts, NLR, d-NLR, PLR, and CRP values can be used as early predictors of mortality in Covid-19 patients. Key Words: Covid-19, Mortality, Emergency, NLR, d-NLR, PLR.

Comparison of saliva and oro-nasopharyngeal swab sample in the molecular diagnosis of COVID-19.

BACKGROUND: Healthcare personnel are at risk of becoming infected while taking upper and/or lower respiratory tract specimens. Therefore, there is a need for sampling methods that do not risk infecting them. In this study, we aimed to compare the saliva and Oro-Nasopharyngeal Swab (ONS) sampling methods. METHODS: Patients were divided into three groups. Group 1 included patients whose diagnosis of COVID-19 was confirmed by polymerase chain reaction (PCR). Group 2 included patients with COVID-19 compatible findings in lung computed tomography (CT), but with a negative PCR. Group 3 included patients who presented to the emergency department with COVID-19 compatible complaints but had normal CT. Saliva and ONS samples were taken on the third day of hospitalization in groups 1 and 2, whereas in group 3, they were taken at the time of admission to the hospital. RESULTS: A total of 64 patients were included in the study. The average age was 51.04 ± 17.9 years, and 37 (57.8%) were male. SARS-CoV-2 was detected in 27 (42.2%) patients' saliva samples. While the sensitivity and positive predictive value of saliva samples were 85.2%, specificity and negative predictive value were 89.2%. The value of kappa was in substantial agreement (0.744), and it was found statistically significant (<0.001). CONCLUSIONS: Saliva samples can be used instead of ONS samples in detecting SARS-CoV-2. Investigating SARS-CoV-2 with saliva is cheaper, easier for the patient and overall, and, most importantly, it poses much less risk of SARS-CoV-2 contamination to healthcare personnel.

The diagnostic process of covid-19 in the emergency department: laboratory and imaging methods.

OBJECTIVES: The 2019 Novel coronavirus disease puts a serious burden on the health system. Therefore, the detection of particularly serious patients at an early stage is extremely important in terms of controlling the outbreak and improving the prognosis. We investigated the role of inflammatory markers studied in patients suspected of COVID-19 at an emergency department in predicting PCR and CT results. METHODS: This retrospective study was carried out with 133 patients who were admitted between 13 March and 1st April 2020 with suspicion of COVID-19. The patients were divided into four groups according to CT and RT-PCR results and evaluated. RESULTS: Considering all patients, no specific findings were found in the hematological and biochemical values of patients in the laboratory analyses. Although all of the results remained within the reference range, there was a significant difference in white blood cell, neutrophil, platelet, and lymphocyte values when the groups were compared [p = 0.000; p = 0.004; p = 0.022; p = 0.023]. CONCLUSION: Laboratory is not specific enough in the pre-diagnosis. In addition, this result does not alter with PCR or CT positivity. However, minimal changes observed in laboratory results may be partially guiding in patients in whom both PCR and CT are positive.

Comparison of saliva and oro-nasopharyngeal swab sample in the molecular diagnosis of COVID-19

SUMMARY BACKGROUND Healthcare personnel are at risk of becoming infected while taking upper and/or lower respiratory tract specimens. Therefore, there is a need for sampling methods that do not risk infecting them. In this study, we aimed to compare the saliva and Oro-Nasopharyngeal Swab (ONS) sampling methods. METHODS Patients were divided into three groups. Group 1 included patients whose diagnosis of COVID-19 was confirmed by polymerase chain reaction (PCR). Group 2 included patients with COVID-19 compatible findings in lung computed tomography (CT), but with a negative PCR. Group 3 included patients who presented to the emergency department with COVID-19 compatible complaints but had normal CT. Saliva and ONS samples were taken on the third day of hospitalization in groups 1 and 2, whereas in group 3, they were taken at the time of admission to the hospital. RESULTS A total of 64 patients were included in the study. The average age was 51.04 ± 17.9 years, and 37 (57.8%) were male. SARS-CoV-2 was detected in 27 (42.2%) patients' saliva samples. While the sensitivity and positive predictive value of saliva samples were 85.2%, specificity and negative predictive value were 89.2%. The value of kappa was in substantial agreement (0.744), and it was found statistically significant (<0.001). CONCLUSIONS Saliva samples can be used instead of ONS samples in detecting SARS-CoV-2. Investigating SARS-CoV-2 with saliva is cheaper, easier for the patient and overall, and, most importantly, it poses much less risk of SARS-CoV-2 contamination to healthcare personnel.

RESUMO OBJETIVO Funcionários da saúde correm risco de infecção ao coletar amostras do trato superior e/ou inferior. Portanto, existe a necessidade de métodos de coleta de amostras que não representem um risco de infecção. Neste estudo, nosso objetivo foi comparar as métodos de coleta de saliva e swab de naso e orofaringe (ONS). MÉTODOS Os pacientes foram divididos em três grupos. O Grupo 1 incluiu pacientes cujo diagnóstico de COVID-19 foi confirmado por reação em cadeia da polimerase (PCR). O Grupo 2 incluiu pacientes com achados compatíveis com COVID-19 em exames de tomografia computadorizada (TC), mas com PCR negativo. O Grupo 3 incluiu pacientes que compareceram ao departamento de emergência com queixas compatíveis com COVID-19, mas TC normal. Amostras de saliva e ONS foram coletadas no terceiro dia de internação, nos Grupos 1 e 2, já no Grupo 3, foram coletadas no momento da internação. RESULTADOS Um total de 64 pacientes foram incluídos no estudo. A média de idade foi de 51,04 ± 17,9 anos, e 37 (57,8%) eram do sexo masculino. SARS-CoV-2 foi detectado em 27 (42,2%) amostras de saliva dos pacientes. A sensibilidade e valor preditivo positivo foi de 85,2% nas amostras de saliva, já a especificidade e o valor preditivo negativo foi 89,2%. O valor de Kappa estava substancialmente de acordo (0,744) e era estatisticamente significante (<0,001). CONCLUSÃO Amostras de saliva podem ser usada em vez de ONS na detecção de SARS-CoV-2. O uso de amostras de saliva para detecção de SARS-CoV-2 é mais barato, mais fácil para o paciente e em geral e, mais importante, representa um risco muito menor de contaminação de SARS-CoV-2 para os profissionais da saúde.

The diagnostic process of covid-19 in the emergency department: laboratory and imaging methods

SUMMARY OBJECTIVES The 2019 Novel coronavirus disease puts a serious burden on the health system. Therefore, the detection of particularly serious patients at an early stage is extremely important in terms of controlling the outbreak and improving the prognosis. We investigated the role of inflammatory markers studied in patients suspected of COVID-19 at an emergency department in predicting PCR and CT results. METHODS This retrospective study was carried out with 133 patients who were admitted between 13 March and 1st April 2020 with suspicion of COVID-19. The patients were divided into four groups according to CT and RT-PCR results and evaluated. RESULTS Considering all patients, no specific findings were found in the hematological and biochemical values of patients in the laboratory analyses. Although all of the results remained within the reference range, there was a significant difference in white blood cell, neutrophil, platelet, and lymphocyte values when the groups were compared [p = 0.000; p = 0.004; p = 0.022; p = 0.023]. CONCLUSION Laboratory is not specific enough in the pre-diagnosis. In addition, this result does not alter with PCR or CT positivity. However, minimal changes observed in laboratory results may be partially guiding in patients in whom both PCR and CT are positive.

RESUMO OBJETIVOS A nova doença de coronavírus de 2019 coloca um fardo sério para o sistema de saúde. Portanto, a detecção de pacientes especialmente graves em um estágio inicial é extremamente importante em termos de controle do surto e melhoria do prognóstico. Investigamos o papel dos marcadores inflamatórios estudados em pacientes suspeitos de COVID-19 no pronto-socorro na previsão de resultados de PCR e CT. MÉTODOS Este estudo retrospectivo foi realizado entre 133 pacientes que foram admitidos entre 13 de março e 1o de abril de 2020 com suspeita de COVID-19. Os pacientes foram divididos em quatro grupos de acordo com os resultados da TC e RT-PCR e avaliados. RESULTADOS Considerando todos os pacientes, não foram encontrados achados específicos nos valores hematológicos e bioquímicos dos pacientes em análises laboratoriais. Embora todos os resultados tenham permanecido dentro do intervalo de referência, houve uma diferença significativa nos valores de glóbulos brancos, neutrófilos, plaquetas e linfócitos quando os grupos foram comparados [p = 0,000; p = 0,004; p = 0,022; p = 0,023]. CONCLUSÃO O laboratório não é suficientemente específico no pré-diagnóstico. Além disso, este resultado não se altera com a positividade para PCR ou CT. No entanto, alterações mínimas observadas nos resultados laboratoriais podem ser parcialmente norteadoras em pacientes com PCR e CT positivos.