Öz
Giriş: Şiddetli Akut Solunum Sendromu-Koronavirüs-2 (SARS-CoV-2) enfeksiyonu için henüz spesifik bir tedavi yoktur. Çalışmamız, favipiravir tedavisi alan şiddetli Koronavirüs hastalığı-2019 (COVID-19) pnömonili hastalarda steroid tedavisinin etkinliğini ve tedaviyi etkileyen faktörleri retrospektif olarak değerlendirmeyi amaçlamıştır.
Gereç ve Yöntem: Bir eğitim ve araştırma hastanesinde 1 Mart-31 Mayıs 2020 tarihleri arasında favipiravir tedavisi kullanan, ağır COVID-19 pnömonili, 18 yaş üstü olgular retrospektif olarak irdelendi. Solunum hızı >30/dakika ve/veya şiddetli solunum sıkıntısı ve oksijen satürasyonu <90 olması ve tipik torasik bilgisayarlı tomografi bulgusu: Bilateral lobüler, periferik lezyonlar, buzlu cam opasitelerinin varlığı şiddetli pnömoni kriteri olarak belirlendi. Şiddetli Akut Solunum Sendromu-CoV-2 polimeraz zincir reaksiyonu sonucu pozitif 82 olgu yaş, cinsiyet, semptomları, komorbiditeleri, mortalite oranları, favipiravir tedavi yanıt, mortalite oranları irdelendi.
Bulgular: Çalışmaya şiddetli pnömoni teşhisi konulan COVID-19 doğrulanmış 82 hasta dahil edildi. Olguların %63’ü erkekti. Hastanın ortanca yaşı 64±16,98 idi (21-97, minimum-maksimum). Kadınlarda mortalite oranı %23 iken erkeklerde %30 idi. Cinsiyet-mortalite ilişkisi istatistiksel olarak anlamlı bulundu (p=0,04). İleri yaş, kronik böbrek yetersizliği ve bilinç bulanıklığı ile hastane başvurusu mortalite ile ilişkili olarak saptandı (p=0,04, p=0,02, p=0,02). Ek tedavi olarak metilprednizolon 12 hastaya verildi. Steroid tedavisi alan ve almayan hastalar istatistiksel olarak değerlendirildiğinde, steroid tedavisi alanlarda mortalite istatistiksel olarak anlamlı bir şekilde düşük saptandı (p=0,017). Steroid tedavisi alan hastalarda bakteriyel enfeksiyon saptanmadı ve prokalsitonin düzeyleri yüksek değildi.
Sonuç: Konfirme COVID-19 hastalarında steroid kullanımı mortalite ve uzun süreli morbiditeleri azaltabilir. Prospektif randomize çalışmalara benzer şekilde bizim çalışmamız da, steroid kullanımının ağır COVID-19 pnömonili hastalarda mortaliteyi azalttığını göstermiştir.
Anahtar Kelimeler: COVID-19, SARS-CoV-2, favipiravir, steroid
Kaynakça
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