Evaluation of Clinical Symptoms, Laboratory Findings, Radiological Characteristics, and Treatments of Adult Patients with Severe COVID-19 Pneumonia

Introduction: In this study, it was aimed to retrospectively evaluate the clinical course, laboratory findings and radiological features of patients with severe Coronavirus disease-2019 (COVID-19) pneumonia in a 200-bed secondary state hospital. Materials and Methods: Male and non-pregnant female patients older than 18 years who were hospitalized with the diagnosis of COVID-19 pneumonia between 01.04.2020-01.07.2020 were included in our study. Severe pneumonia was defined as the presence of tachypnea (>30 breaths/ min) and/or hypoxia (SpO2 <90% room air) and/or bilateral diffuse ground-glass infiltrations. Conformity of continuous data to normal distribution was evaluated with Kolmogorov-Smirnov and Shapiro-Wilk tests. In the analysis of the relationship between laboratory parameters and mortality, independent groups t-test was used for parametric data and Mann-Whitney U test was used for non-parametric data. Results: Sixty two (60.8%) of the patients were male, with a mean age of 60.2 +/- 16.1 years (n=102). Of the study group 76.5% had at least one or more comorbid diseases. The most common comorbidities were hypertension (60.3%), diabetes mellitus (42.3%) and coronary artery disease (26.9%). The most common symptoms observed in patients at the time of admission were cough (n=63, 61.8%), dyspnea (n=57, 55.9%), fever (n=33, 32.4%) and malaise (n=22, 21.6%). Severe acute respiratory syndrome-Coronavirus-2 polymerase chain reaction test was positive in 68% (n=70) of the patients. Blood culture was taken from 42.3% of the patients who were admitted with the complaint of fever and there was no detected culture growth. During the hospitalization period, the rate of patients who received any of the antibiotic treatments including azithromycin, clarithromycin, moxifloxacin was 90.2% and 66.7% (n=68) of them were treated with azithromycin. Of the patients 42.2% (n=43) required treatment in the intensive care unit. A favorable clinical response was observed in 74.5% (n=77) of the patients and nine of these patients were discharged with partial recovery and recommendation for home oxygen support therapy. The mortality rate was 24.5% (n=25). The mean of lactate dehydrogenase level and the mean urea level were higher in the group with mortality (p <= 0.001). Conclusion: Despite the low rates of bacterial coinfection and/or secondary bacterial infection in COVID-19, frequently given antibiotic treatments contribute to the problem of antimicrobial resistance, creating a serious public health problem and causing an economic burden. Large-scale randomized controlled trials are required for treatment protocols of which potential benefits have not yet been proven.