ABSTRACT
Introduction: The use of immunosuppression in patients with severe COVID has been recommended as the standard of care. However, it's use in concomitant bacterial sepsis could result in adverse outcomes. Aim(s): We analyzed the use of immunosuppression in the form of corticosteroids among patients who succumbed to COVID 19. Method(s): Patients died with COVID 19 at the intensive care unit (ICU), National Hospital, Kandy, Sri Lanka from 01.01.2021 to 31.12.2021 were retrospectively studied. Result(s): 79 deaths were analyzed. Majority were males (46/79);median age was 63 years (19, 94). The mean hospital and ICU stay were 11 days (interquartile range-IQR:7,14), 7days (IQR: 2.5,9) subsequently. 75/79 received corticosteroids, Dexamethasone(n=55), Methyl Prednisolone-MPP(n=9), Prednisolone(n=12) had been used either as a single or sequential therapy. The median daily dose and median duration were as follows. Dexamethasone: 6mg (2,10)- 7 days (1,18), MPP 750mg (500,1000)-3days (2,3), Prednisolone: 30mg (5,40)-2days (1,10). 25/46 demonstrated bacterial co-infection either with PCT>1 or blood or urine culture positivity. 24/25 with sepsis received Dexamethasone. One of them received MPP and Dexamethasone sequentially. Conclusion(s): Higher proportion of patients with bacterial co-infection were concomitantly treated with higher doses of corticosteroids,which could resulted in the adverse outcome.
ABSTRACT
Introduction: The clinical and laboratory characteristics of patients who died with COVID 19 yet to be elucidated. Aims and objectives: We were aiming at identifying potential contributory factors for the mortality in COVID 19. Method(s): Patients died with COVID 19 at the intensive care unit (ICU), National Hospital, Kandy, Sri Lanka from 01.01.2021 to 31.12.2021 were retrospectively studied. Result(s): 79 deaths were analyzed. Males (44/79);median age 63 years (19, 94). Mean hospital and ICU stay were11 days (interquartile range-IQR:7,14), 7days (IQR: 2.5,9) subsequently. Median of 2 comorbidities (0,5) were present;diabetes(n=43), hypertension(n=43), ischemic heart disease(n=21), chronic kidney disease(n=10), post kidney transplant recipients(n=10), other(n=10). 14/79 had none. Mean systolic blood pressure on admission:130 mmHg (IQR: 115,148), mean SpO2/FiO2 ratio was 147(IQR 95,163), mean serum lactate level was 1.9(IQR: 1.08,2.25). The average heart rate 95(IQR: 81,108);mean respiratory rate was 28(IQR: 22, 33);mean random blood sugar was 229(IQR: 156, 289). 15/79 documented to be vaccinated (one =4/11: two=6/15: three=5/15). C-Reactive protein was available in 72/79;mean=122(IQR: 38, 182). Procalcitonin (PCT) on admission was available in 32/79;median=3.70 (0.01, 96), PCT was >1 in 16/32. 8/18 blood culture samples, 4/12urine culture samples detected bacterial pathogens. 25/46 demonstrated either PCT>1 or blood and/or urine culture positivity. Conclusion(s): Higher proportion of patients were unvaccinated, with multiple comorbidities predominantly diabetes. Hyperinflammation was common and significant proportion had bacterial co-infection.