الفهرس 
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Abstract
The newly emergent human severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), resulting in epidemics and pandemics. As of April 18th 2020, SARS-CoV-2 has caused more than 2,000,000 infections and 100,000 deaths worldwide. The COVID-19 pandemic has placed a tremendous burden on healthcare and public health systems worldwide. In an attempt to improve pandemic response, there has been sustained research interest in investigating potential biological characteristics which could be used as markers for COVID-19 risk, severity, or SARS-CoV-2 infection status. This so-called ‘risk factor epidemiology’ is appealing because prediction or early identification of individuals who will get sick, need to be hospitalized, or die could allow more targeted public health measures and reduce the pressure on overburdened systems. A number of high-profile studies on ABO blood type as a risk factor for COVID-19 outcomes have drawn the attention of the public. In particular, a genome wide association study (GWAS) showed a positive association between Type A blood group and risk of COVID-19 infection, and a negative association between Type O blood group and risk of COVID-19 infection. Several other studies seemed to support these findings, and this confluence of study results has been used as evidence to suggest the existence of a true biological relationship between ABO blood type and
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COVID-19 risk or severity. This has led to a (incorrect) belief among members of the public that individuals with Type O blood are not at risk of COVID-19 or cannot contract SARS-CoV-2. Although it may be tempting to conclude agreement between study results suggests strong evidence in support of the use of ABO blood type to predict COVID-19 outcomes, this is not necessarily correct. A number of studies have suggested that liver disease is one of the most common comorbidities of COVID-19 patients and a number of patients infected with SARS-CoV-2 can develop different degrees of liver injury. To monitor liver damage, bilirubin levels are a universally accepted marker. Patients with elevated bilirubin tended to have worse prognoses and more severe disease. The main aim of this study was to evaluate the ABO blood type and indirect bilirubin to predict early mortality in adults with severs COVID-19. This retrospective observational study was conducted on 268 adult patients with laboratory-confirmed Covid-19 attended to the hospitals and intensive care units (ICU), Qena general hospital and Luxor International Hospital and other hospitals or centers for the treatment of Covid-19, during the period of the study from January 2021 till December 2021.
The main results of the study revealed that:
Mean age among included cases was 58.13 years with male predominance 64.9% of cases, As regard presenting symptoms
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67.5% of cases had fever, 67.5% had myalgia, 64.2% had respiratory symptoms and 35.8% had digestive symptoms, 65.7% of cases had co morbidities and 34.3% were free, most common co morbidities was HTN in 54.5%, asthma in 34.1% and DM in 29%, renal in 17.6% of cases and rheumatoid in 8.5%.
As regard ABO among included Non O group in 68% of cases and O group in 32%, 34.3% of cases admitted to medical floor and 65.7% ICU admission,As regard treatment used all cases received antiviral therapy , 56% received anticoagulant , 31.7% received antibiotic , and steroids given in 12.7% of cases , 58.6% of cases received non invasive mechanical ventilation, 34% Invasive mechanical ventilation and high oxygen flow nasal cannula given for 7.5% of cases.
As regard early ICU mortality within 7 days were 34.7% among included cases, Mortality rate was 58.2% among included cases during hospitalization
Mean Time from illness onset to ICU admission in days was 9.49 , median Time from illness onset to death or discharge in days was 11.0 (7.0 – 20.0), median hospital stay was 7.0 (6.0 – 9.0)days
There was insignificant differences between survivor and non survivor as regard sex, age p-value <0.001, As regard symptoms there was significant higher in fever, myalgia among cases died with p-value <0.001. There was significant higher in comorbidities among cases died p-value <0.001,
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There was significant higher in respiratory rate, heart rate and low oxygen saturation among died cases with p-value <0.001, There was significant higher in INR, PTT, D-dimer, fibrinogen, CRP and Procalcitonin among died cases than alive cases, there was significant differences between died and alive cases as regard WBCs, Platelet, Neutrophil, Lymphocyte, Albumin, AST, ALT, creatinine and urea, There was significant higher of ICU admission among died cases p-value <0.001. There was significant differences between died and alive cases as regard type of treatment given. There was significant higher in mechanical ventilation either invasive or non invasive among died cases p-value <0.001.
The Cut off level which discriminate between survivor and non survivor Univariate and multivariate logistic regression analysis was used regarding total bilirubin hazard ration 0.182 in died cases than alive , indirecr bilirubin hazard ration was 894.2 in died cases than alive cases , and D dimer was 0.039 in died cases than alive cases.
Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.