ABSTRACT
Background: Information regarding the incidence and characteristics of COVID-19 pneumonia amongst pregnant women is scarce. Methods: Single-centre experience with 32 pregnant women diagnosed with COVID-19 between March 5 to April 5, 2020 at Madrid, Spain. Findings: COVID-19 pneumonia was diagnosed in 61.5% (32/52) women. Only 18.7% (6/32) had some underlying condition (mostly asthma). Supplemental oxygen therapy was required in 18 patients (56.3%), with high-flow requirements in six (18.7%). Eight patients (25.0%) fulfilled the criteria for acute distress respiratory syndrome. Invasive mechanical ventilation was required in two patients (6.2%). Tocilizumab was administered in five patients (15.6%). Delivery was precipitated due to COVID-19 in three women (9.4%). All the newborns had a favourable outcome, with no cases of neonatal SARS-CoV-2 transmission. Severe cases of pneumonia requiring supplemental oxygen were more likely to exhibit bilateral alveolar or interstitial infiltrates on chest X-ray (55.6% vs. 0.0%;P-value = 0.003) and serum C-reactive protein (CRP) levels >10 mg/dL (33.0% vs. 0.0%;P-value = 0.05) at admission than those with no oxygen requirements. Interpretation: Pregnant women with COVID-19 have a high risk of developing pneumonia, with a severe course in more than half of cases. The presence of bilateral kung infiltrates and elevated serum CRP at admission may identify women at-risk of severe COVID-19 pneumonia. (C) 2020 The Author(s). Published by Elsevier Ltd.
ABSTRACT
This observational retrospective study aimed to investigate the usefulness of Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), National Early Warning Score (NEWS), and quick NEWS in predicting respiratory failure and death among patients with COVID-19 hospitalized outside of intensive care units (ICU). We included 237 adults hospitalized with COVID-19 who were followed-up on for one month or until death. Respiratory failure was defined as a PaO2/FiO2 ratio ≤200mmHg or the need for mechanical ventilation. Respiratory failure occurred in 77 patients (32.5%), 29 patients (12%) were admitted to the ICU, and 49 patients (20.7%) died. Discrimination of respiratory failure was slightly higher in NEWS, followed by SOFA. Regarding mortality, SOFA was more accurate than the other scores. In conclusion, sepsis scores are useful for predicting respiratory failure and mortality in COVID-19 patients. A NEWS score ≥4 was found to be the best cutoff point for predicting respiratory failure.
Subject(s)
COVID-19 , Respiratory Insufficiency , Sepsis , Adult , COVID-19/complications , Hospital Mortality , Humans , Intensive Care Units , Organ Dysfunction Scores , Prognosis , ROC Curve , Retrospective StudiesABSTRACT
This observational retrospective study aimed to investigate the usefulness of Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), National Early Warning Score (NEWS), and quick NEWS in predicting respiratory failure and death among patients with COVID-19 hospitalized outside of intensive care units (ICU). We included 237 adults hospitalized with COVID-19 who were followed-up on for one month or until death. Respiratory failure was defined as a PaO2/FiO2 ratio ≤ 200 mmHg or the need for mechanical ventilation. Respiratory failure occurred in 77 patients (32.5%), 29 patients (12%) were admitted to the ICU, and 49 patients (20.7%) died. Discrimination of respiratory failure was slightly higher in NEWS, followed by SOFA. Regarding mortality, SOFA was more accurate than the other scores. In conclusion, sepsis scores are useful for predicting respiratory failure and mortality in COVID-19 patients. A NEWS score ≥ 4 was found to be the best cutoff point for predicting respiratory failure.
ABSTRACT
Objective: to analyse the frequency of cognitive impairment and other neurological comorbidities in deceased COVID-19 patients, during the outbreak of the pandemic in Madrid, Spain. Methods: retrospective, single-center, hospital-based study. We included adults that died after admission from March 1 to March 31, 2020, at Hospital Universitario 12 De Octubre. Clinical and demographic data were extracted from electronic medical records. Results: 477 cases: 58 with probable COVID-19, 281 confirmed COVID-19, and 138 who died of other causes. Comparing the latter two groups, median age (81.4 years vs. 78.1 years;p<0.01) and the proportion of males (62.3% vs. 49.3%, p<0.01) were higher in the confirmed COVID-19 group. The number of comorbidities was high and similar in both groups, and cognitive impairment was common (29.9%;21.1% dementia;8.9% mild cognitive impairment) in confirmed COVID-19. In this group group, subjects with cognitive impairment were older (median 85.8 years vs. 79.0 years, p<0.0001), more lived in nursing homes and had slightly shorter times from symptom onset to death than those without cognitive impairment. COVID-19 patients with cognitive impairment were rarely admitted to the ICU, and fewer received non-invasive mechanical ventilation (7.1% vs. 25.4%, <0.0001). Palliative care was provided in more subjects with cognitive impairment (79.2% vs. 66.3%, p=0.038). Conclusions: in our study, dead patients with confirmed COVID-19 were older and had more comorbidities than those reported in the Asian population. Cognitive impairment is a frequent comorbidity in COVID-19 deceased patients. The burden of COVID-19 in the dementia community will be high.