ABSTRACT
Background. Coronavirus disease (COVID-19) is associated with significant morbidity and mortality. This study aimed to explore the early predictors of intensive care unit (ICU) admission and in-hospital mortality among patients diagnosed with COVID-19. Methods. This was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29 - May 29, 2020. For each case enrolled, one control was matched by age and gender. Results. A total of 1560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range = 18). Predictors independently associated with ICU admission were cardiovascular disease (CVD) (adjusted odds ratio (aOR)=1.64, 95% confidence interval (CI): 1.16 - 2.32, p=0.005), diabetes (aOR=1.52, 95% CI: 1.08 - 2.13, p= 0.016), obesity (aOR=1.46, 95% CI: 1.03-2.08, p= 0.034), lymphopenia (aOR=2.69, 95% CI: 1.80-4.02, p< 0.001), high aspartate aminotransferase (AST) (aOR= 2.59, 95% CI: 1.53-4.36, p< 0.001), high ferritin (aOR=1.96, 95% CI: 1.40-2.74, p< 0.001), high C-reactive protein (CRP) (aOR=4.09, 95% CI: 2.81-5.96, p< 0.001), and dyspnea (aOR=2.50, 95% CI: 1.77-3.54, p< 0.001). Similarly, significant predictors of mortality included CVD (aOR=2.16, 95% CI: 1.32- 3.53, p=0.002), diabetes (aOR=1.77, 95% CI: 1.07-2.90, p=0.025), cancer (aOR=4.65, 95% CI: 1.50-14.42, p= 0.008), lymphopenia (aOR=2.34, 95% CI: 1.45-3.78, p= 0.001), and high AST (aOR= 1.89, 95% CI: 1.04-3.43, p=0.036). Risk Factors for ICU admission among patients with COVID-19 (N=1560) Conclusion. Having CVD, diabetes, lymphopenia, and increased AST were independent predictors for both ICU admission and in-hospital mortality in patients with COVID-19. In addition, obesity, high ferritin, and CRP levels were associated with increased risk of ICU admission, while cancer was strongly associated with in-hospital mortality. Early identification and monitoring of patients at risk is essential in planning the level of care needed to prevent delay in medical intervention.
ABSTRACT
Purpose This study aimed to explore the early predictors of intensive care unit (ICU) admission and in-hospital mortality among patients diagnosed with Coronavirus disease (COVID-19). Methods & Materials This was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29 - May 29, 2020. For each case enrolled, one control was matched by age and gender. Univariate and multivariate logistic regression models were used to identify the predictors for ICU admission and in-hospital mortality among the COVID‐19 patients. Results A total of 1560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range, IQR=18). Predictors independently associated with ICU admission included having cardiovascular disease (CVD) (adjusted odds ratio (aOR)=1.64, 95% confidence interval (CI): 1.16 - 2.32, p= 0.005), diabetes (aOR=1.52, 95% CI: 1.08 - 2.13, p= 0.016), body mass index ≥30 kg/m2 (aOR=1.46, 95% CI: 1.03-2.08, p= 0.034), lymphocytes ≤0.8 × 103/μL (aOR=2.69, 95% CI: 1.80-4.02, p<0.001), aspartate aminotransferase (AST) >120 U/L (aOR= 2.59, 95% CI: 1.53-4.36, p<0.001), ferritin >600 μg/L (aOR=1.96, 95% CI: 1.40-2.74, p<0.001), C-reactive protein (CRP) >100 mg/L (aOR=4.09, 95% CI: 2.81-5.96, p<0.001), and dyspnea (aOR=2.50, 95% CI: 1.77-3.54, p <0.001). Similarly, significant predictors of mortality included CVD (aOR=2.16, 95% CI: 1.32- 3.53, p=0.002), diabetes (aOR=1.77, 95% CI: 1.07-2.90, p=0.025), cancer (aOR=4.65, 95% CI: 1.50-14.42, p= 0.008), lymphocytes ≤0.8 x,103/μL (aOR=2.34, 95% CI: 1.45-3.78, p= 0.001), and AST >120 U/L (aOR= 1.89, 95% CI: 1.04-3.43, p=0.036). Conclusion Having CVD, diabetes, lymphopenia, and increased AST were independent predictors for both ICU admission and in-hospital mortality in patients with COVID-19. In addition, obesity, high ferritin, and CRP levels were also associated with increased risk of ICU admission, while cancer was strongly associated with in-hospital mortality. Early identification and monitoring of patients at risk is essential in planning the level of care needed to prevent delay in medical intervention.
ABSTRACT
Introduction: Around one in every five people in Qatar has bronchial asthma. Asthma may be associated with worse Coronavirus disease 2019 (COVID-19) outcomes. Research Question or Hypothesis: What are the characteristics and outcomes of adult asthmatic patients presenting with COVID-19 and what factors, including asthma medications, are associated with worse disease outcomes? Study Design: Retrospective observational cohort study Methods: Adult patients with documented history of asthma and laboratory-confirmed diagnosis of COVID-19 were included. Relevant data was retrieved through electronic chart review. Descriptive statistics were used to summarize the characteristics and the outcomes of the study cohort. Factors independently associated with COVID-19 related hospitalization were determined by multivariable logistic regression models. Results: Between March and August 2020, 616 patients met the inclusion criteria, of whom 52% were females. Median age was 44 years (interquartile range [IQR], 34-57 years). Forty-four percent of patients received inhaled corticosteroids (ICS) and 41.7% received long-acting beta agonists (LABA). Montelukast and tiotropium were used by 17.9% and 2.9% of patients, respectively. One patient was receiving long term oral corticosteroid and two patients were on biological agents. The most common comorbidities were hypertension (31%) and diabetes (27.1%). Two-hundred thirty-six patients (38.3%) required hospitalization for COVID-19, with a median hospital stay of 10 days (IQR, 5-15). Invasive mechanical ventilation was required in 26 patients (4.2%) and 16 patients (2.6%) died. The need for hospitalization was independently associated with older age (odds ratio [OR] for 10-years, 1.32;95% confidence interval [CI], 1.13-1.54) and hypertension (OR, 2.4;95% CI, 1.43-3.93) but not with the use of ICS, LABA, montelukast or tiotropium. Conclusion: In Qatar, adult patients with asthma appear to be at higher risk of COVID-19 related hospitalization compared to the general adult COVID-19 infected population. Older age and hypertension were associated with worse outcomes while asthma medications were not.
ABSTRACT
Introduction: Coronavirus disease 2019 (COVID-19) pandemic has created an unprecedented pressure on healthcare systems, resulting in widespread adoption of innovative technology and services including provision of pharmaceutical care through telepharmacy. This practice is novel in the state of Qatar and the lessons learned by clinical pharmacists who provide the service is unknown. Research Question or Hypothesis: What are the perceived benefits, risks, barriers, and facilitators related to the use of telepharmacy for the provision of pharmaceutical care during COVID-19 pandemic from the perspective of clinical pharmacists? Study Design: A qualitative methodology using focus group discussions Methods: Clinical pharmacists across Hamad Medical Corporation were purposively selected to participate in the study. Focus group discussions were audio-recorded, and transcribed verbatim. Data were analyzed using inductive thematic analysis. Results: Five focus groups, involving 24 pharmacists were conducted. Overall, the major perceived benefits of care provision through telepharmacy included decreased infection exposure risks, continuity of access to healthcare services, better resource utilization through deceased time and cost on patients, and expansion of clinical pharmacy services to cover higher number of patients in remote facilities. However, clinical pharmacists perceived the practice of telepharmacy as difficult and challenging. The major disadvantages highlighted were limited efficiency and timeliness of clinical pharmacy interventions;suboptimal patient communication due to language barrier;negative influence on the pre-established professional rapport with other healthcare providers, leading to reluctance to seek pharmacists' input. Perceived challenges of the service included lack of standardized training and timely access to patients' information, cultural resistance by both healthcare providers and patients and limited resources such as dedicated platforms, incomplete documentation in electronic health records. Participants recommended creating dedicated platforms and standardized protocols as potential facilitators of telepharmacy. Conclusion: Despite perceived barriers, pharmacists identified several benefits of telepharmacy and recommended potential facilitators that should be utilized to integrate and sustain the practice of telepharmacy in the future.