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INTRODUCCIÓN: La mortalidad por pacientes por COVID-19 grave que desarrollaban neumonía grave y síndrome de dificultad respiratoria agudo (SDRA) grave ha sido significativa a pesar del tratamiento oportuno. Es importante determinar predictores tempranos de enfermedad que nos ayuden a estratificar aquellos pacientes con mayor riesgo de fallecer. Se pretende estudiar el comportamiento del puntaje APP (APPS) como predictor de ello, basados en algunos reportes de uso y utilidad en el SDRA. no COVID-19. OBJETIVO: Determinar si el APPS es útil como predictor de mortalidad en SDRA. por COVID-19 grave. PACIENTES Y MÉTODO: Se realizó un estudio tipo cohorte retrospectivo, incluyendo pacientes de la Unidad de Cuidados Intensivos (UCI), con SDRA. por COVID-19 grave, que ingresaron a la UCI del Hospital Regional Docente de Trujillo (HRDT) en el período abril 2020- abril 2021. Se evalúo la utilidad del APPS como predictor de mortalidad em dicha población. RESULTADOS: El APPS demostró ser un factor asociado a mortalidad en pacientes con SDRA. y COVID-19 grave (RPa 1,34; IC 95% 1,16 a 1,56; p < 0,001). Además, encontramos que, al realizar un modelo de predicción ajustado por edad, sexo, SOFA, APPS, shock, Indice de Charlson (ICh), se comportan como factores asociados a mortalidad el APPS, el sexo masculino (RPa: 1,48; IC 95% 1,09 a 2,049; p < 0,05) y el ICh (RPa: 1,11; IC 95% 1,02 a 1,21; p < 0,05). CONCLUSIÓN: El APPS, el sexo masculino y el ICh son predictores de mortalidad en SDRA. por COVID-19 grave.
BACKGROUND: Mortality in patients with severe COVID-19 who developed severe pneumonia and severe Acute Respiratory Distress Syndrome (ARDS) has been significant despite timely treatment. It is important to determine early predictors of disease that help us to stratify those patients with a higher risk of death. It is intended to study the behavior of the APPS score as a predictor of this, based on some reports of use and usefulness in non-COVID-19 ARDS. AIM: To determine if the APP score is useful as a predictor of mortality in ARDS due to severe COVID-19. METHOD: A retrospective cohort study was carried out, including patients from the Intensive Care Unit (ICU) with ARDS due to severe COVID-19 who were admitted to the ICU of the Trujillo Regional Teaching Hospital (HRDT) in the period March 2020 to March 2021. The usefulness of the APP score as a predictor of mortality in mentioned population was evaluated. RESULTS: The APP score proved to be a factor associated with mortality in patients with ARDS and severe COVID-19 (APR 1.34; 95% CI 1.16 to 1.56; p < 0.001). We also found that when performing a prediction model adjusted for age, sex, SOFA, APP score, shock and Charlson Index (ICh) we found that the APP score, male sex (APR: 1.48; 95% CI 1.09 to 2.049; p < 0.05) and the ICh behave as factors associated with mortality (RPa: 1.11; 95% CI 1.02 to 1.21; p < 0.05). CONCLUSION: The APP score, male sex, and ICh are predictors of mortality in ARDS due to severe COVID-19.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Respiratory Distress Syndrome, Newborn/mortality , COVID-19/complications , Multivariate Analysis , Predictive Value of Tests , Retrospective Studies , ROC Curve , Hospital Mortality , COVID-19/mortality , Intensive Care UnitsABSTRACT
Resumen Antecedentes: La información acerca del deterioro funcional después de una hospitalización por COVID-19 es limitada en personas mayores (PM). Objetivo: Determinar la asociación entre marcadores de inflamación (ferritina), coagulación (dímero D), factores clínicos y el estado funcional de PM que padecieron COVID-19 a seis meses del alta hospitalaria en México. Material y métodos: Estudio de cohorte ambispectiva de 158 pacientes mayores de 65 años hospitalizados por COVID-19 moderado-grave con expediente electrónico completo que permitiera recolectar información y contactarlos a los seis meses del alta. Se definió deterioro funcional como disminución ≥ 10 puntos del índice de Barthel. Mediante regresión logística se determinó el riesgo de asociación entre factores bioquímicos y clínicos y deterioro funcional en el tiempo de seguimiento. Resultados: 46.2 % de los participantes presentó pérdida funcional. Los factores asociados fueron edad ≥ 73 años (RM = 2.53), enfermedad renal crónica (RM = 4.57), puntuación ABC-Goals ≥ 8 (RM = 2.4), ferritina ≥ 605 ng/mL (RM = 3.94) y dímero-D ≥ 930 ng/mL FEU (RM = 17.56). Conclusión: La infección por COVID-19 no solo representa una enfermedad con alto riesgo de mortalidad durante la fase aguda, sino que también se asocia a un alto riesgo de deterioro funcional posterior al egreso hospitalario.
Abstract Background: The information on functional decline after hospitalization for COVID-19 is limited in older adults (OAs). Objective: To determine the association of inflammation (ferritin) and coagulation markers (D-dimer) and clinical factors with the functional status of OAs who suffered from COVID-19 six months after hospital discharge in Mexico. Material and methods: Ambispective cohort study of 158 patients older than 65 years hospitalized for moderate-severe COVID-19 with complete electronic records that would allow to collect information and to contact them six months after discharge. Functional impairment was defined as a decrease ≥ 10 points on the Barthel index. Using logistic regression analysis, the risk of association of biochemical and clinical factors with functional deterioration during follow-up was determined. Results: 46.2 % of participants exhibited functional decline. Associated factors included age ≥ 73 years (OR = 2.53), chronic kidney disease (OR = 4.57), an ABC-Goals score ≥ 8 (OR = 2.4), ferritin ≥ 605 ng/mL (OR = 3.94) and D-dimer ≥ 930 ng/mL (OR = 17.56). Conclusion: COVID-19 infection did not only represent a disease with a high risk of mortality during the acute phase, but is also associated with a high risk of functional impairment after hospital discharge.
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ABSTRACT BACKGROUND: The frequency of coronavirus disease 2019 (COVID-19) cases among asthmatics has been reported to be reduced. However, the findings regarding the association between asthma and the risk of severe COVID-19 have been divergent. OBJECTIVE: To investigate whether asthma is associated with a reduced risk of development of severe COVID-19. DESIGN AND SETTING: Retrospective analysis on COVID-19 surveillance databases at two tertiary-level hospitals in São Paulo, Brazil. METHODS: The medical records of patients hospitalized due to COVID-19 between March and August 2020 were reviewed in accordance with the clinical, laboratorial, radiological and epidemiological criteria for COVID-19, and for comorbidities. RESULTS: Among the adult patients included (> 18 years of age) there were 52 asthmatics and 1,318 non-asthmatics. Their median ages and interquartile ranges (IQR) were, respectively, 54 (41-69) and 60 (44-72) years. At least one comorbidity was seen in 73% of asthmatics and 56% of the non-asthmatics. Among the asthmatics, most presented mild asthma (92%) and the prevalence of chronic obstructive pulmonary disease (COPD) was high (27%). The asthmatics presented an unadjusted odds ratio (OR) for severe COVID-19 of 0.89 (95% confidence interval, CI 0.5-1.56); and OR 0.88 (95% CI 0.5 -1.68) after multivariable adjustment. Age > 60 years, male sex, hypertension, diabetes, cancer and homelessness were covariates associated with increased odds for severe COVID-19. Kaplan-Meier estimated survival over hospitalization of up to 30 days did not differ between the groups (log-rank P = 0.09). CONCLUSIONS: The association between asthma and decreased risk of severe COVID-19 or increased survival was statistically non-significant.
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Background: The outbreak of coronavirus disease 2019 (COVID-19) caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in China, in December 2019, and was declared a pandemic by WHO on March 11, 2020. The treatment is evolving and is mostly supportive in nature. Material and methods: This was a single-center retrospective study that included confirmed COVID-19 cases treated at our institute (a tertiary care hospital in Jammu and Kashmir, India), between March 2020 and December 2020. Patients with age more than 18 years were included in the study. Results: On evaluating the effect of various drug therapies used in management of COVID-19 patients of all severity, use of remdesivir and famotidine was associated with significantly higher odds of survival. In subgroup of patients with severe disease, use of systemic steroids was associated with significantly higher odds of survival in addition to remdesivir and famotidine. In patients with severe COVID-19 illness, likelihood of survival was significantly higher in those who received combination of systemic steroids plus remdesivir compared to steroids and remdesivir alone. Conclusion: Steroids were effective in severe COVID-19 illness and the combination of steroids and remdesivir was more effective in severe illness. There is a need to undertake more large scale prospective randomized trials to determine the most effective drug therapies to treat the sick patients and prevent worsening of mild cases.
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Establecer la validez diagnóstica de la escala CALL como predictor de mortalidad en pacientes con COVID-19 severo en Unidad de Cuidados Intensivos del Hospital Regional Docente de Trujillo desde abril del 2020 hasta julio del 2021. Material y métodos: Se llevó a cabo un estudio analítico, retrospectivo, en el cual se incluyeron a 177 pacientes con COVID-19 severo internados en Unidad de Cuidados Intensivos del Hospital Regional Docente de Trujillo, según criterios de selección, se calculó la escala CALL para cada uno y se asoció con la mortalidad encontrada; aplicándose la prueba estadística chi cuadrado; posteriormente se realizó un análisis de regresión multivariante para identificar los factores de riesgo asociados a la mortalidad. A su vez se utilizó el AUROC (área bajo la curva ROC) para establecer el rendimiento predictivo de la escala CALL. Resultados: De una muestra de 177 pacientes, al analizar la información mediante la curva ROC, se obtuvo un valor de corte 6 puntos para la escala CALL, con un área bajo la curva (AUC) de 0.612 (p=0,014); sensibilidad, especificidad, valor predictivo positivo y negativo de 86%, 29%, 60% y 62% respectivamente. No se encontraron diferencias significativas estadísticamente en cuanto a sexo, edad, shock séptico, SOFA, índice de comorbilidad de Charlson, necesidad de TRR ni compliance estática. En cambio, se evidenció asociación con la PaO2/FiO2(AU)
To establish the diagnostic validity of the CALL score as a predictor of mortality in patients with severe COVID-19 in the Intensive Care Unit of the Trujillo Regional Teaching Hospital from April 2020 to July 2021.Material and methods: An analytical, retrospective study was carried out, in which 177 patients with severe COVID-19 admitted to the Intensive Care Unit of the Regional Teaching Hospital of Trujillo were included, according to selection criteria, the CALL score was calculated for each one and was associated with the mortality found; applying the statistical chi 2 test; Subsequently, a multivariate regression analysis was performed to identify risk factors associated with mortality. In turn, the AUROC (area under the ROC curve) was used to establish the predictive performance of the CALL score. Results: From a sample of 177 patients, when analyzing the information using the ROC curve, a cut-off value of 6 points was obtained for the CALL score, with an area under the curve (AUC) of 0.612 (p=0.014); sensitivity, specificity, positive and negative predictive value of 86%, 29%, 60% and 62% respectively. No statistically significant differences were found in terms of sex, age, septic shock, SOFA, Charlson comorbidity index, need for renal replacement therapy (RRT) or static compliance. On the other hand, an association with PaO2 / FiO2 was evidenced(AU)
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Humans , Male , Female , Adult , Middle Aged , Aged , Respiration, Artificial , Critical Care , COVID-19/mortality , Intensive Care Units , Respiratory Distress Syndrome, Newborn , Retrospective Studies , Risk FactorsABSTRACT
SUMMARY OBJETIVE Coronavirus disease 2019 (COVID-19) has quickly turned into a health problem globally. Early and effective predictors of disease severity are needed to improve the management of the patients affected with COVID-19. Copeptin, a 39-amino acid glycopeptide, is known as a C-terminal unit of the precursor pre-provasopressin (pre-proAVP). Activation of AVP system stimulates copeptin secretion in equimolar amounts with AVP. This study aimed to determine serum copeptin levels in the patients with COVID-19 and to examine the relationship between serum copeptin levels and the severity of the disease. METHODS The study included 90 patients with COVID-19. The patients with COVID-19 were divided into two groups according to disease severity as mild/moderate disease (n=35) and severe disease (n=55). All basic demographic and clinical data of the patients were recorded and blood samples were collected. RESULTS Copeptin levels were significantly higher in the patients with severe COVID-19 compared with the patients with mild/moderate COVID-19 (p<0.001). Copeptin levels were correlated with ferritin and fibrinogen levels positively (r=0.32, p=0.002 and r=0.25, p=0.019, respectively), and correlated with oxygen saturation negatively (r=-0.37, p<0.001). In the multivariate logistic regression analysis, it was revealed that copeptin (OR: 2.647, 95%CI 1.272-5.510; p=0.009) was an independent predictor of severe COVID-19 disease. A cutoff value of 7.84 ng/mL for copeptin predicted severe COVID-19 with a sensitivity of 78% and a specificity of 80% (AUC: 0.869, 95%CI 0.797-0.940; p<0.001). CONCLUSION Copeptin could be used as a favorable prognostic biomarker while determining the disease severity in COVID-19.
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Humans , COVID-19 , Prognosis , Glycopeptides , Biomarkers , SARS-CoV-2ABSTRACT
The prognosis of COVID-19 (coronavirus disease 2019) is usually poor when it occurs in aged adults or in patients with chronic diseases, which brought a great challenge to clinical practice. Furthermore, widespread depression, anxiety, and panic related to SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) infection affected treatment compliance and recovery. Here we report the successful treatment of a 57-year-old male with severe COVID-19, schizophrenia, hypertension, and type 2 diabetes. The patient's negative emotions (such as tension, panic, and anxiety), particularly his aggression and paranoia, seriously hindered treatment, leading to a deteriorating condition. Psychological counseling and supportive psychotherapy were given but the effect was weak. To improve adherence, risperidone and quetiapine fumarate were replaced by olanzapine for anti-schizophrenic treatment to reduce insomnia and anxiety side effects, associated with sedative-hypnotic drugs as well as psychological counseling. The treatment compliance of the patient improved significantly. The patient's serum alanine aminotransferase increased abnormally in the late stage of hospitalization, suggesting potential liver damage after complex medication strategies. We also monitored the changes of lymphocyte subsets and retrospectively analyzed the virus-specific antibody response. The results suggested that dynamic monitoring of lymphocyte subsets and virus-specific antibody response could facilitate disease progression evaluation and timely treatment plan adjustments. An effective psychotropic drug intervention associated with psychological counselling and psychotherapy are essential for the successful adherence, treatment, and rehabilitation of psychiatric disorders in COVID-19 patients.
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Humans , Male , Middle Aged , Schizophrenia/complications , Schizophrenia/drug therapy , COVID-19 , Chronic Disease , Retrospective Studies , Diabetes Mellitus, Type 2 , SARS-CoV-2ABSTRACT
Introduction : Dans sa politique de riposte contre la pandémie liée à l'infection au SARS-COV2, le Bénin a opté pour la construction d'Hôpitaux dédiés exclusivement à la prise en charge des COVID19. Pendant la première vague de la pandémie en Afrique, les systèmes de santé n'étaient pas encore bien outillés pour faire face à cette pandémie. Nous vous rapportons l'expérience des soins intensifs du Centre de traitement des épidémies (CTE) d'ALLADA. Objectifs : évaluer la prise en charges des cas graves de COVID19 à l'USI du CTE ALLADA. Matériels et méthode : Il s'est agi d'une étude prospective, descriptive et analytique, réalisée aux soins intensifs du centre de traitement des épidémies d'ALLADA, du 1er juin au 31 Août 2020. Résultats : Quatre-vingt-quatorze malades étaient éligibles pour notre étude. L'âge moyen des malades était de 58,41 ans, le sex-ratio 1,61. Les comorbidités les plus représentatives étaient l'hypertension artérielle (70,21%), le diabète (31,91%), l'obésité morbide (21,28%) et l'asthme (15,96%). Selon le score de gravité adopté au Bénin, trente-six malades (38,30%) étaient classés cas graves grade3 et ont bénéficié d'une ventilation mécanique. La VNI était la technique de ventilation la plus utilisée (75% des cas). Le plateau technique était limité et les ressources humaines qualifiées insuffisantes. Les associations chloroquine/azithromycine ou lopinavir/ritonavir/ribavirine étaient les traitements spécifiques utilisés. La mortalité était de 27,66%. Conclusion : Malgré les conditions de travail difficiles, notamment le plateau technique limité et les ressources humaines qualifiées insuffisantes, les résultats obtenus après traitement des cas graves de COVID19 à l'USI du CTE ALLADA étaient encourageants
Introduction: To respond to the pandemic linked to the SARS-COV-2 infection, Benin has opted for the construction of hospitals dedicated exclusively to the treatment of COVID-19. During the first wave of the pandemic in Africa, health systems were not yet well equipped to deal with this pandemic. We here report the Intensive CareUnit (ICU) experience of the Epidemic Treatment Center of ALLADA (ETCA). Purpose: To assess the management of serious cases of COVID-19 in the ICU of ETCA. Materials and method: This was a prospective, descriptive and analytical study, carried out in the ICU of ETCA, from June 1 to August 31, 2020. Results: Ninety-four patients were eligible for our study. The average age of the patients was 58.41 years with a sex ratio of 1.61. The most representative comorbidities were arterial hypertension (70.21%), diabetes (31.91%), morbid obesity (21.28%) and asthma (15.96%). According to the severity score adopted in Benin, thirty-six patients (38.30%) were classified as severe grade III cases and received mechanical ventilation. Non-Invasive Ventilation (NIV) was the most used ventilation technique (75% of cases). The technical platform was limited and the qualified human resources were insufficient. Chloroquine/azithromycin or lopinavir / ritonavir/ribavirine were the specific treatments used. Mortality was 27.66%. Conclusion: Despite the difficult working conditions, especially the limited technical platform and insufficient qualified human resources, the results obtained after treatment of serious cases of COVID-19 at the ICU of ETCA were encouraging