Relationship between AB0 and Rh Blood Groups in COVID-19 Patients and In-Hospital Mortality

According to the Berlin classification10, Group 3 consisted of patients who had PaO2/FiO2 between 200-300 mild ARDS (Acute respiratory distress syndrome) or more than 300 non-ARDS and whose clinical condition is not severe, nasal oxygen support was sufficient. Patients older than 18 years of age, whose blood group information was registered in the hospital database system, and who had positive PCR (Polymerase Chain Reaction) test results were included in the study. Patients whose blood group information was not registered in the hospital database system and PCR test results were negative, and who were younger than 18 years of age were excluded from the study. [...]we did not find a significant difference between AB0 and Rh blood groups and disease severity in patients with mild clinical findings and intensive care patients with moderate-severe clinical findings.

Optic Nerve Sheath Diameter, Intensive Care Unit admission & COVID-19-Related-In-hospital Mortality.

BACKGROUND: Hypoxia and hypercapnia due to acute pulmonary failure in patients with coronavirus disease 2019 (COVID-19) can increase the intracranial pressure (ICP). ICP correlated with the optic nerve sheath diameter (ONSD) on ultrasonography and is associated with a poor prognosis. AIM: We investigated the capability of ONSD measured during admission to the intensive care unit (ICU) in patients with critical COVID-19 in predicting in-hospital mortality. METHODS: A total of 91 patients enrolled in the study were divided into two groups: survivor (n = 48) and nonsurvivor (n = 43) groups. ONSD was measured by ultrasonography within the first 3 h of ICU admission. RESULTS: The median ONSD was higher in the nonsurvivor group than in the survivor group (5.95 mm vs. 4.15 mm, p < 0.001). The multivariate Cox proportional hazard regression analysis between ONSD and in-hospital mortality (contains 26 covariates) was significant (adjusted hazard ratio, 4.12; 95% confidence interval, 1.46-11.55; p = 0.007). The ONSD cutoff for predicting mortality during ICU admission was 5 mm (area under the curve, 0.985; sensitivity, 98%; and specificity, 90%). The median survival of patients with ONSD >5 mm (43%; n = 39) was lower than those with ONSD ≤ 5 mm (57%; n = 52) (11.5 days vs 13.2 days; log-rank test p = 0.001). CONCLUSIONS: ONSD ultrasonography during ICU admission may be an important, cheap, and easy-to-apply method that can be used to predict mortality in the early period in patients with critical COVID-19.

COVID-19 Pnömonisi Sonrasi Geç Dönemde Görülen Spontan Pnömotoraks Olgusu

Amaç: COVID-19 hastalarında pnömoni sık görülürken, pnömotoraks gibi plevral boşluğun tutulumu nadir olarak meydana gelir. Bu hastalarda pnömotoraks, erken teşhis ve çoğunlukla hızlı şekilde toraks tüpü takılmasını gerektiren, nadir görülen bir komplikasyondur. COVID-19 sonrası geç dönemde nadir görülen spontan pnömotoraksı literatür eşliğinde ve görüntülerle birlikte tartışmayı amaçlıyoruz. Olgu: Otuz dokuz yaşında erkek hasta, ateş, öksürük, nefes darlığı ve eklem ağrısı şikayetiyle hastanemize başvurdu. Geliş vitalleri A: 39 N: 70, Ta: 120/87, So: 94. Toraks BT COVID uyumludur. PCR pozitiftir. Hasta 5 günlük takip ve tedavi sonrası taburcu edilmiştir. Kırk beş gün sonra ani başlayan göğüste batıcı-delici tarzda ağrı, şıkışma hissi ve nefes darlığı şikayetiyle hastanemize tekrar başvurdu. Geliş vitalleri A: 36,2, N: 97, Ta: 129/78, So: 90’dır. Çekilen toraks BT’de sol akciğerde pnömotoraks ve buzlu cam görüntüleri saptandı. Hastaya toraks tüpü takılmadan klinik olarak takip edildi. Klinik ve radyolojik olarak düzelen hasta taburcu edildi. Sonuç: COVID-19 şiddetli akciğer hasarı ve yaygın alveolar hasarı içeren değişikliklerin spontan pnömotoraks mekanizmasına katkıda bulunduğu düşünülmektedir. Ayrıca mekanik ventilasyon da risk faktörü olarak bilinmektedir. Başka tetikleyici faktör uzun COVID-19 sonrası geç dönemde nadir görülen ve atlandığında hayati tehlike oluşturabilen spontan pnömotoraksın ayrıcı tanılarımızda yer alması gerektiğini düşünmekteyiz. Üreli öksürüktür. Hastamızda gelişen olası alveoler hasar ve kronik öksürüğün spontan pnömotoraksa neden olduğunu düşünmekteyiz. COVID-19 sonrası geç dönemde nadir görülen ve atlandığında hayati tehlike oluşturabilen spontan pnömotoraksın ayrıcı tanılarımızda yer alması gerektiğini düşünmekteyiz. (Turkish) [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Association of 25-Hydroxyvitamin D Level with COVID-19-Related in-Hospital Mortality: A Retrospective Cohort Study.

BACKGROUND: The primary aim of this study was to compare the 25(OH)D level between patients with COVID-19 and the reference population. The secondary aim was to determine the association of 25(OH)D level with COVID-19-related in-hospital mortality. METHODS: The COVID-19-positive group comprised 520 hospitalized patients and the reference population comprised 15,789 COVID-19-negative patients. The 25(OH)D level was categorized as vitamin D deficiency (25[OH]D < 20 ng/mL) and severe vitamin D deficiency (25[OH]D < 12 ng/mL). RESULTS: While the incidence of vitamin D deficiency was similar in both groups, the incidence of severe vitamin D deficiency was higher in patients with COVID-19 than in the reference population (68.3% [n = 355] vs. 55.1% [n = 8,692], p < 0.001). Severe vitamin D deficiency in patients with COVID-19 was higher in the intensive care unit (ICU) group than in the non-ICU group (75.3% [n = 183] vs. 62% [n = 172], p = 0.001). The incidence of severe vitamin D deficiency was 65.4% (n = 280) in survivors and 81.5% (n = 75) in nonsurvivors (p = 0.003). However, multivariable Cox proportional hazard regression analysis showed no relationship between 25(OH)D level and in-hospital mortality. The median survival times of patients with and without severe vitamin D deficiency were not different, as shown by Kaplan-Meier survival analysis. CONCLUSION: Severe vitamin D deficiency is more common in patients with COVID-19 and may play a significant role in worsening the prognosis of these patients. However, the 25(OH)D level was not observed to effect COVID-19-related in-hospital mortality.

The effect of high-dose parenteral vitamin D3 on COVID-19-related inhospital mortality in critical COVID-19 patients during intensive care unit admission: an observational cohort study.

BACKGROUND: In many studies, vitamin D has been found to be low in COVID-19 patients. In this study, we aimed to investigate the relationship between clinical course and inhospital mortality with parenteral administration of high-dose vitamin D3 within the first 24 h of admission to patients who were hospitalized in the intensive care unit (ICU) because of COVID-19 with vitamin D deficiency. METHODS: This study included 175 COVID-19 patients with vitamin D deficiency [25(OH) D <12 ng/mL] who were hospitalized in the ICU. Vitamin D3 group (n = 113) included patients who received a single dose of 300,000 IU vitamin D3 intramuscularly. Vitamin D3 was not administered to the control group (n = 62). RESULTS: Median C-reactive protein level was 10.8 mg/dL in the vitamin D3 group and 10.6 mg/dL in the control group (p = 0.465). Thirty-nine percent (n = 44) of the patients in the vitamin D3 group were intubated endotracheally, and 50% (n = 31) of the patients in the control group were intubated endotracheally (p = 0.157). Parenteral vitamin D3 administration was not associated with inhospital mortality by multivariate logistic regression analysis. According to Kaplan-Meier survival analysis, the median survival time was 16 d in the vitamin D3 group and 17 d in the control group (log-rank test, p = 0.459). CONCLUSION: In this study, which was performed for the first time in the literature, it was observed that high-dose parenteral vitamin D3 administration in critical COVID-19 patients with vitamin D deficiency during admission to the ICU did not reduce the need for intubation, length of hospital stay, and inhospital mortality.

Could serum total cortisol level at admission predict mortality due to coronavirus disease 2019 in the intensive care unit? A prospective study.

BACKGROUND: Critical diseases usually cause hypercortisolemia via activation of the hypothalamic-pituitary-adrenal axis. OBJECTIVES: To investigate the relationship between serum total cortisol level and mortality among coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU), at the time of their admission. DESIGN AND SETTING: Prospective study developed in a pandemic hospital in the city of Sirnak, Turkey. METHODS: We compared the serum total cortisol levels of 285 patients (141 COVID-19-negative patients and 144 COVID-19-positive patients) followed up in the ICU. RESULTS: The median cortisol level of COVID-19-positive patients was higher than that of COVID-19 negative patients (21.84 µg/dl versus 16.47 µg/dl; P < 0.001). In multivariate logistic regression analysis, mortality was associated with higher cortisol level (odds ratio: 1.20; 95% confidence interval: 1.08-1.35; P = 0.001). The cortisol cutoff point was 31 µg/dl (855 nmol/l) for predicting mortality among COVID-19-positive patients (area under the curve 0.932; sensitivity 59%; and specificity 95%). Among the COVID-19 positive patients with cortisol level ≤ 31 µg/dl (79%; 114 patients), the median survival was higher than among those with cortisol level > 31 µg/dl (21%; 30 patients) (32 days versus 19 days; log-rank test P < 0.001). CONCLUSION: Very high cortisol levels are associated with severe illness and increased risk of death, among COVID-19 patients in the ICU.

The prognostic impact of thyroid disorders on the clinical severity of COVID-19: Results of single-centre pandemic hospital.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause thyroid hormonal disorders. In addition, tracheal compression by thyroid nodules can aggravate hypoxia in critically ill patients. No studies have investigated the effect of thyroid nodules on the prognosis of patients with COVID-19. In this study, we investigated the effect of thyroid hormonal disorders and thyroid nodules on the prognosis of patients with COVID-19. MATERIALS AND METHODS: This prospective study was conducted at the Sirnak State Hospital (Pandemic hospital in Turkey) between 15 March and 15 August 2020. We evaluated thyroid hormonal disorder and thyroid nodules in 125 patients who were admitted to the non-intensive care unit (non-ICU) due to mild COVID-19 pneumonia (group 1) and 125 critically ill patients who were admitted to the ICU (group 2). RESULTS: Thyroid-stimulating hormone levels (TSH) were not significantly different between groups 1 and 2; however, group 2 patients had significantly lower levels of free thyroxine (FT4) and free triiodothyronine (FT3) as compared to group 1 (P = .005, P < .0001, respectively). FT3 level showed a negative correlation with length of hospital stay and C-reactive protein level (rho: -0.216, p: 0.001; rho: -0.383, P < .0001). Overt thyroid disorder was observed in 13 patients [2 patients in group 1 (both with overt thyrotoxicosis) and 11 patients in group 2 (3 overt hypothyroidism, 8 overt thyrotoxicosis) (P = .01)]. Thyroid nodules sized ≥1 cm were found in 9 patients (7%) in group 1 and 32 patients (26%) in group 2 (P < .0001). CONCLUSION: Overt thyroid hormonal disorders were more common in critically ill COVID-19 patients. FT3 level at hospital admission is a potential prognostic marker of COVID-19 patients. Thyroid nodules may be associated with severe COVID-19 disease.