ABSTRACT
Objective: This retrospective and prospective cohort study was designed to describe the characteristics, treatments, and outcomes of patients with SARS-CoV-2 infection (COVID-19) admitted to subintensive care units (SICU) and to identify the variables associated with outcomes. SICUs have been extremely stressed during the pandemic, but most data regarding critically ill COVID-19 patients come from intensive care units (ICUs). Studies about COVID-19 patients in SICUs are lacking. Setting and participants: The study included 88 COVID-19 patients admitted to our SICU in Cuneo, Italy, between March and May 2020. Measurements: Clinical and ventilatory data were collected, and patients were divided by outcome. Multivariable logistic regression analysis examined the variables associated with negative outcomes (transfer to the ICU, palliation, or death in a SICU). Results: A total of 60 patients (68%) had a positive outcome, and 28 patients (32%) had a negative outcome;69 patients (78%) underwent continuous positive airway pressure (CPAP). Pronation (n=37 [42%]) had been more frequently adopted in patients who had a positive outcome vs a negative outcome (n=30 [50%] vs n=7 [25%];P=.048), and the median (interquartile range) Pao2/Fio2 ratio after 6 hours of prone positioning was lower in patients who had a negative outcome vs a positive outcome (144 [140-168] vs 249 [195-268], P=.006). Independent predictors of a negative outcome were diabetes (odds ratio [OR], 8.22;95% CI, 1.50-44.70;P=.015), higher D-dimer (OR, 1.28;95% CI, 1.04-1.57;P=.019), higher lactate dehydrogenase level (OR, 1.003;95% CI, 1.000-1.006;P=.039), and lower lymphocytes count (OR, 0.996;95% CI, 0.993-0.999;P=.004). Conclusion: SICUs have a fundamental role in the treatment of critically ill patients with COVID-19, who require long-term CPAP and pronation cycles. Diabetes, lymphopenia, and high D-dimer and LDH levels are associated with negative outcomes.
ABSTRACT
After the outbreak of the Covid-19 pandemic, cases of SARS-CoV-2 infections may gradually decrease in the next months. Given the reduced prevalence of the disease, Emergency Departments (ED) are starting to receive more and more non-Covid-19 patients. Thus, a way to quickly discriminate ED patients with potential Covid-19 infection from non-Covid-19 patients is needed in order to keep potentially contagious patients isolated while awaiting second-level testing. In this paper, we present the derivation and validation of a simple, practical, and cheap score that could be helpful to rule out Covid-19 among ED patients with suspicious symptoms (fever and/or dyspnoea). The LCL score was derived from a cohort of 335 patients coming to the ED of our hospital from March 16th to April 1st, 2020. It was then retrospectively validated in a similar cohort of 173 patients admitted to our ED during April. The score is based on blood values of lactate dehydrogenase, C-reactive protein, and lymphocyte count. The LCL score performed well both in the derivation and in the validation cohort, with an AUC respectively of 0.81 (95% CI: 0.77 - 0.86) and of 0.71 (95% CI: 0.63 - 0.78), given the difference in Covid-19 prevalence between the two cohorts (57% vs 41% respectively). An LCL score equal to 0 had a negative predictive value of 0.92 in the derivation cohort and of 0.81 in the validation cohort, with a negative likelihood ratio respectively of 0.08 and 0.36 for Covid-19 exclusion. This score could, therefore, constitute a useful tool to help physicians manage patients in the ED.