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Introduction: According to a substantial body of research, electrolyte abnormalities are a common manifestation in coronavirus disease 2019 (COVID-19) patients and are associated with adverse outcomes. This study aimed to investigate electrolyte imbalances in COVID-19 patients and assess their relation to mortality. Method(s): Adult COVID-19 patients hospitalized in the Security Forces Hospital in Saudi Arabia from June 8th till August 18th, 2020 were enrolled in this retrospective observational study. We examined baseline characteristics, comorbidities, acute organ injuries, medications, and electrolyte levels including sodium, potassium, chloride, calcium, bicarbonate, phosphate, and magnesium on ICU admission, as well as every following day of ICU stay, until death or discharge. Patients were stratified according to survival, and differences in variables between groups were compared using Mann-Whitney's U test or Fisher's exact test. Longitudinal electrolyte profiles were modeled using random intercept linear regression models. Result(s): A total of 60 COVID-19 patients were enrolled. Compared to survivors, non-survivors had significantly higher sodium and phosphate on admission and death, higher potassium and magnesium at death, and significantly lower calcium at death. Abnormalities in admission levels of chloride and bicarbonate were also more frequently observed in non-survivors. Furthermore, in the deceased group, we observed a daily increase in potassium and phosphate levels, and a daily decrease in sodium and chloride. Finally, calcium increased in non-survivors over time, however, not as significantly as in the survivor group. Conclusion(s): Admission levels of electrolytes and changes over the course of ICU stay appear to be associated with mortality in COVID-19 patients.Copyright © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
ABSTRACT
Background: Emerging evidence suggests that liver dysfunction in the course of coronavirus disease 2019 (COVID-19) illness is a critical prognostic factor for mortality in COVID-19 patients, and the Fibrosis-4 (FIB-4) score, developed to reflect level of hepatic fibrosis, has been associated with adverse outcomes in hospitalized COVID-19 patients. This study aimed to investigate intensive care unit (ICU) admitted patients, a high-risk subpopulation, research on which is lacking. Materials and Methods: This retrospective cohort study examined FIB-4 scores and clinical endpoints including death, acute cardiac injury (ACI), acute kidney injury, and need for mechanical ventilation in critically ill COVID-19 patients, without prior hepatic disease, throughout ICU stay. Results: Of 60 patients enrolled, 35% had ICU admission FIB-4 >2.67. Among nonsurvivors, FIB-4 was significantly higher at admission (median 3.19 vs. 1.44;P < 0.001) and only a minority normalized <1.45 (36.0%). Each one-unit increment in admission FIB-4 was associated with 67.4% increased odds of death (95% confidence interval [CI], 9.8%-162.6%;P = 0.017). FIB-4 >2.67 was associated with a median survival time of 18 days from ICU admission versus 40 days with FIB-4 <2.67 (P = 0.016). Admission FIB-4 was also higher in patients developing ACI (median 4.99 vs. 1.76;P < 0.001). FIB-4 correlated with age (r = 0.449;P < 0.001), and aspartate transaminase with alanine transaminase (r = 0.674;P < 0.001) and lactate dehydrogenase (r = 0.618;P < 0.001). Conclusion: High ICU admission FIB-4 is associated with mortality in critically ill COVID-19 patients, with failure to normalize at time of death, however, the high score is likely a result of generalized cytotoxicity rather than advanced hepatic fibrosis.
ABSTRACT
Objectives: Prone ventilation is believed to improve oxygenation parameters in patients with severe coronavirus disease 2019 (COVID-19). However, the efficacy and safety profiles of prone ventilation among intubated COVID-19 patients remain unclear. The primary objective of this systematic review was to examine the effect of prone ventilation on the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) in intubated COVID-19 patients. Methods: Databases of MEDLINE, EMBASE and CENTRAL were systematically searched for any clinical trials or observational studies comparing prone versus supine position of ventilation in intubated COVID-19 patients from their inception until March 2021. Case reports and case series were excluded. Results: A total of 11 studies (n=606 patients) were included for quantitative meta-analysis. Prone ventilation improved PaO2/FiO2 ratio (studies=8, n=579, mean difference 46.75, 95%CI 33.35-60.15, p<0.00001;evidence=very low) and peripheral oxygen saturation (studies=3, n=432, mean difference 1.67, 95%CI 1.08-2.26, p<0.00001;evidence=low), both of which were statistically significant in intubated COVID-19 patients. However, no significant differences were observed in the arterial partial pressure of carbon dioxide (studies=5, n=396, mean difference 2.45, 95%CI -2.39-7.30, p = 0.32;evidence= very low), mortality rate (studies=1, n=215, odds ratio 0.66, 95%CI 0.32-1.33, p=0.24;evidence= very low) and number of patients discharged alive (studies=1, n=43, odds ratio 1.49, 95%CI 0.72-3.08, p=0.28;evidence=very low). However, none of the studies investigated the adverse events of both supine and prone ventilation in COVID-19 patients. Conclusions: This meta-analysis demonstrated that prone ventilation improved PaO2/FiO2 ratio and SpO2 in intubated COVID-19 patients. More randomized controlled trials are warranted to examine the adverse events of prone ventilation, and to improve the certainty of evidence and its homogeneity. (Figure Presented) .
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Objective: To study the role for preoperative CT chest scans in suspected COVID-19 patients requiring emergent surgery. Design: Retrospective - observational. Participants: A total of 98 patients admitted for emergency surgery with COVID-19 infection and underwent preoperative CT chest scanning. Main outcome measurements: Incidence of clinical symptoms of COVID-19 infection upon presentation, imaging characteristics in chest CT and semi-quantitative CT severity score. Results: The median age of the study cohorts was 50 years (interquartile range (IQR): 40-60 years) and 52/98 (53.1%) were males. The most common symptoms were fever (80.6%) and cough (65.3%). 50/98 had positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR test prior to CT scan, while 48/98 had positive reverse transcriptase-polymerase chain reaction (RT-PCR) result returned after imaging. The imaging characteristics were bilateral infiltrates on CT of 90/98, with 70/98 of infiltrates located peripherally and 28/98 located peripherally and centrally. The most common disease pattern was ground-glass opacities, observed in 95/98. The median total COVID-19 CT severity score was 7 (IQR: 4-14), corresponding to 5-25% global lung involvement. Conclusion: Patients with mild symptomatic COVID-19 in this study displayed CT evidence of SARS-CoV-2 infection. Preoperative CT imaging should be considered for identifying suspected active SARS-CoV-2 cases in resource limited environments with high community spread, to aid in resource allocation and personal protective equipment (PPE) rationing.
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BACKGROUND AND AIMS: Reduction of atherogenic lipoproteins is often the ultimate goal of nutritional interventions, however this is complicated given that hypolipidemia is frequently observed in coronavirus disease 2019 (COVID-19) patients. We aimed to explore the association of hypolipidemia with patient outcomes in terms of immunothrombosis and multiorgan injury, focusing on specialized apolipoproteins apo A1 and apo B. METHODS: Lipid profiles of 50 COVID-19 patients and 30 sick controls presenting to the Emergency Department (ED) were measured in this prospective observational study. The primary outcome was development of severe acute kidney injury (AKI). Need for hospitalization and ICU admission were secondary outcomes. Lipoproteins were analyzed for independent association with serum creatinine (SCr) increase ratio and correlated with a wide panel of biomarkers. RESULTS: COVID-19 cohort had significantly lower apo A1 (p = 0.006), and higher apo B/apo A1 ratio (p = 0.041). Patients developing severe AKI had significantly lower LDL-C (p = 0.021). Apo B/apo A1 was associated with 2.25-fold decrease in serum SCr increase ratio, while LDL-C with a 1.5% decrease. Hypolipidemia correlated with low plasminogen, ADAMTS13 activity/VWF:Ag, and high inflammatory biomarkers (CRP, IL-6, IL-8, IL-10), plasminogen activator inhibitor-1 (PAI-1), ED creatinine, and SCr increase ratio. CONCLUSION: Although favored in dietetics, findings of a low LDL-C in COVID-19 patients should be alarming in light of our observations. Low apo B/apo A1 ratio and LDL-C are predictive of renal deterioration in COVID-19 patients, and low LDL-C in particular may potentially serve to indicate COVID-19 related AKI driven by disrupted fibrinolysis and a secondary thrombotic microangiopathy-like process.