Efficacy of clinical guidelines in the treatment of severe forms of a novel coronavirus infection in children

Intensive therapy of severe COVID-19 is one of the most difficult problems of modern intensive care. Objective. To assess the effectiveness of clinical guidelines in the treatment of severe forms of a new coronavirus infection in children. Material and methods. A retrospective controlled non-randomized multiple-center study enrolled 111 ICU children from 40 hospitals. Specialists of the Federal Remote Intensive Care Counselling Centre counseled all patients. Children were divided into 2 groups («recovery» and «death») depending on the outcome. Results. pSOFA score 2 (1—5) at admission was associated with 19.5-fold increase of mortality risk (OR 19.5, 95% Cl 2.3—165.7). We found higher score «respiratory distress» item in all patients regardless the outcome. Antibacterial, corticosteroid therapy and vasopressor support significantly affected the outcome of disease (X2=18.202;df=3, p=0.000), while infusion, respiratory, anticoagulant therapy and enteral nutrition were less significant, especially in pSOFA score ≤4 points (X2=15.521;df=5, p=0.008). Mortality risk decreased in no need for increase of initial doses of catecholamines (OR 0.2, 95% 0=0.1—0.7). Less compliance with recommendations for correction of antibacterial and corticosteroid therapy was followed by higher mortality (OR 5.2, 95% Cl 1.4—18.9 and OR 3.4, 95% Cl 1.1—10.8, respectively). Conclusion. Timely strict implementation of clinical guidelines, adequate catecholamine support, antibacterial and corticosteroid therapy in children with COVID-19 significantly reduce the likelihood of mortality. © 2022, Media Sphera Publishing Group. All rights reserved.

Risk Factors of Transfer to Mechanical Ventilation of COVID-19 Patients in a Retrospective Non-Randomized Study

Background. The COVID-19 pandemic is associated with significant number of complications and mortality and a burden on the healthcare system. In 10–15% of hospitalized patients, the invasive and non-invasive mechanical ventilation (IMV/NIMV) is required. At the same time, it is important to stratify the risk of mechanical ventilation upon admission to the hospital. Aims — to identify clinical and laboratory risk factors for transfer to IMV and NIMV in hospitalized patients with COVID-19-associated pneumonia. Methods. A retrospective one-center nonrandomized study of 386 consecutive hospitalized patients with COVID-19-associated pneumonia was performed. The primary endpoints were IMV (n = 22) and NIMV (n = 28). Risk factors of artificial ventilation were considered for periods up to 14 and 28 days for both variants. To select a risk predictor, a univariate analysis based on Cox survival regression was performed, followed by multivariate analysis to determine risk factors at these time points. Results. After 28 days from admission the mortal exit was registered in 20 patients from 386 patients (5.2%). 22 patients (5.7%) were transferred to IMV, and 28 patients (7.3%) — to NIV, and 9 of the latter were transferred later to IMV. As a result of univariate and multivariate analyzes, the risk factors for transfer to mechanical ventilation on 14th day were: age > 65 years (OR = 5.91), a history of stroke (OR = 17.04), an increased serum level of urea (OR = 6.36), LDH (OR = 7.39), decreased sodium (OR = 12.32), GFR < 80 mL/min/1.73 m2 (OR = 13.75) and platelets (OR = 4.14);on the 28th day — age > 65 years (OR = 4.58), J-wave on the ECG (OR = 2.98), an increase of LDH (OR = 9.99) and a decrease in albumin (OR = 2.77) in serum. Predictors of the transfer of patients with COVID-19 to NIV within the period up to 14 days from the beginning of hospitalization were the age > 65 years (OR = 5.09), procalcitonin level in the blood > 0.25 ng/ml (OR = 0.19), leukocytes > 11×109 (OR = 19.64) and increased LDH (OR = 3.9). Conclusions. In patients with COVID-19, the risk factors for transfer to IMV/NIVL in the period of 14 and 28 days from the beginning of hospitalization were identified, which enable patient’s mechanical ventilation stratification and to plan respiratory support resources.

Predictors of death in severe new coronavirus infection in children

Currently, in pandemic settings, the new coronavirus infection is the leading cause of adult fatalities and may cause death of children with comorbidities. The objective of the study is to identify predictors of the fatality of the new coronavirus infection in children. Subjects and Methods. 230 patients with the new coronavirus infections were examined. The main group of 94 patients with severe COVID-19, the fatal outcome occurred in 25 (26.6%) children. The comparison group consisted of 126 children with a moderate degree of severity, and there were no lethal outcomes. Results. Children older than 10 years of age (43%) prevailed in the study cohort. Every fifth patient in the main group suffered from shock, and 79 (84%) children had failure of two or more systems/organs. The presence of pronounced manifestations of the disease was associated with a 20-fold increase in the probability of a severe course of COVID-19 (OR = 0.04). Involvement of two organs and systems doubled the risk of death. An acceptable discriminatory ability of the pSOFA score for predicting COVID-19 outcomes in children was identified: sensitivity 83%, specificity 61%, cut-off point 5.6 points. Conclusion. Predictors of death in severe new coronavirus infection in children include failure of two or more organs and systems, acute renal injury and the pSOFA score above 5. © 2021 Tomsk Polytechnic University, Publishing House. All rights reserved.