Predictive models of intensive care unit admission in patients with covid-19: systematic review

Background: It is essential to identify the epidemiological and clinical characteristics of patients infected with COVID-19 associated with disease progression leading to ICU admission. The objective was to systematically review the models or scores for predicting admission to the intensive care unit (ICU) available to date for patients with COVID-19. Methods: The study is a systematic review. PubMed, Scopus, Web of Science, Ovid-Medline, and Embase were searched until July 13, 2022. We included studies that have developed and validated a model or scoring system to predict ICU admission in patients with COVID-19. The primary outcome was ICU admission. Risk of bias assessment was performed using the PROBAST tool which is based on four domains: participants, predictors, outcome and analysis. Results: Two studies were included for data extraction and critical appraisal. Predictive models of ICU admission and performance were obtained as primary outcomes. Common predictors for both models were associated with pulmonary compromise (respiratory rate or pulmonary ventilation) and systemic inflammation (C-reactive protein). Conclusions: It is feasible to determine predictor variables for ICU admission in patients hospitalized for COVID-19. However, the studies do not determine a clearly defined score and present a high risk of bias, so it is not feasible to recommend the application of any of these models in clinical practice. © 2022 Publicado por Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo.

Time of contagion of patients with SARS-CoV-2: Analysis at ten months of pandemic

Under the current circumstances of the COVID-19 pandemic and given the possibility of collapse of health systems due to the increase in infections worldwide, it is necessary to establish the time in which a patient infected with SARS-CoV-2 maintains the contagious condition. Determining the infectious agent's transmissibility phase with greater precision will serve to standardize the isolation period of the patient and will prevent the spread of the virus at the community level and its safe return to work. Through molecular tests it has been established that viral RNA is detectable in the respiratory tract from 2 to 3 days before the manifestation of symptoms, reaching its maximum level at the onset of symptoms and decreasing progressively in the following 7 or 8 days in most of patients. However, persistent detection of viral RNA by RT-PCR does not necessarily mean that the patient remains infectious. It has been reported that in mild and moderate cases of COVID-19, the repli-cative capacity of the virus lasts until day 9 from the onset of symptoms, while, in severe and critical cases, it lasts until day 20 from the onset of symptoms. Currently, the strategies proposed by the WHO and the CDC to define the isolation time of those infected are based on the time of manifestation of symptoms and the clinical evolution of the patient. © 2021, Universidad Nacional de Colombia. All rights reserved.