ABSTRACT
Introduction: Hospitalized COVID-19 patients commonly develop pulmonary complications and respiratory insufficiency. Prediction of respiratory deterioration in hospitalized COVID-19 patients is an unmet goal. Aim(s): To assess monitoring of lung fluid status of hospitalized COVID-19 patients to predict respiratory deterioration and prognosis. ClinicalTrials.gov Identifier: NCT04406493. Method(s): Study population comprised 51 patients hospitalized in Hillel Yaffe Medical Center with COVID-19 infection. Patient lung fluid status was monitored by repeat measurements of the lung impedance (LI), a technique found to be very effective for monitoring and guiding treatment of heart failure patients. Decreasing LI reflects lung fluid accumulation. Clinical and laboratory parameters, chest X-ray and LI level were recorded during hospitalization. Result(s): Of 51 patients hospitalized for COVID-19 infection (37- men and 14- women, 55.7+/-12.6 years-old), 46 were discharged alive after successful treatment and of these 27 returned for follow-up evaluation 3-6 months after discharge. In these patients' admission LI was 72.6+/-18.4 Ohms (Figure 1) and discharge LI was 83.8+/-20.7 Ohms, which is 15% higher than the admission value (p< 0.04). LI at the follow up visit was surprisingly low (63.7+/-15 Ohms), or 31.6% lower than discharge value (p<0.01, figure 1). At follow up, examination of the patients and the NT-proBNP tests were within normal limits. Using our previous experience we calculated the normal ("dry") LI based on the age, sex, weight, height and anthropology of the chest. The calculated values of the normal LI of patients in time of post-discharge visits were exactly same as measured. Therefore, the LI values of patients in time of hospitalization were higher than their normal values. This finding contrasts with our experience with heart failure patients, where decreasing LI reflects lung fluid accumulation. The possible explanation of this finding is that the lung fluid of COVID-19 patients, containing a high concentration of proteins, has different conductivity properties than the lung fluid of heart failure patients. Conclusion(s): Decreasing of LI level at post-discharge visits of COVID-19 patients 3-6 months after hospitalization differs significantly from the pattern in heart failure patients.Copyright © 2022
ABSTRACT
Introduction: Prediction of the clinical deterioration in hospitalized COVOD-19 patients is an unmet goal. Aim(s): To assess monitoring of lung fluid status of hospitalized COVID-19 patients as a tool to predict clinical respiratory deterioration and prognosis. Method(s): The present study population comprised 51 patients hospitalized in our medical center with COVID-19 infection. The lung fluid status of patients was monitored by repeat measurements the lung impedance (LI). The LI technique was found to be a very effective tool for monitoring and guiding the treatment of a heart failure patients. Decreasing LI reflects lung fluid accumulation. Clinical and laboratory parameters, chest X-ray (CXR) and LI level were recorded during hospitalization. Result(s): Of the 51 patients hospitalized for COVID-19 infection (37 men and 14 women, 55.7+/-12.6 years old), 46 were discharged after successful treatment (Group 1) and 5 (9.8%) died during hospitalization (Group 2). The LI kinetics during hospitalization demonstrated a different pattern between groups (Figure 1, p<0.01). In group 1 patients, a small LI decrease (-3.5+/-4.3%, p=0.7) during the first 4 days (median = 2.2 days, [Q1- 3: 1-3.7 days]) of hospitalization was noted. Following this, LI increased progressively until discharge (+20.3+/-12.3%, p<0.01). Among group 2 patients, LI decreased progressively during hospitalization. Mechanical ventilation was initiated at the eighth day [median = 8, Q1-3: 4-12 days] when LI decreased by 18.2+/-3.8% in comparison with the admission level (p<0.01). Deaths occurred at 12.4+/-2.7 days (median = 12 days) after admission. Multivariate Cox regression analysis of clinical, laboratory and CXR variance has shown that the degree of LI decrease during hospitalization is the most reliable predictor of death (hazard ratio: 1.36 [1.04-1.79], p<0.04). Conclusion(s): The combination of progressively decreasing LI after 4 days of hospitalization for COVID-19 infection and an LI decrease >15% is the most reliable predictor of death.
ABSTRACT
Background: A reduction in acute myocardial infarction (AMI) hospitalizations during the coronavirus pandemic has been previously documented. We aimed to describe the characteristics and in-hospital outcomes of AMI patients during the Covid-19 era compared to a recent previous registry. Methods: We conducted a prospective, multicenter, observational study involving 13 intensive cardiac care units (ICCUs) to evaluate consecutive AMI patients admitted throughout an 8-week period during the Covid-19 outbreak. Data were compared to the corresponding period in 2018 using an acute coronary syndrome survey conducted in all ICCUs in Israel. The primary end-point was defined as a composite of sustained ventricular arrhythmia, pulmonary congestion, and/or in-hospital mortality. Results: The study cohort comprised 1466 patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with ST-elevation MI (STEMI): 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. No differences were detected in the admission rate of patients between the two study periods. STEMI patients admitted during the Covid-19 period tended to have fewer co-morbidities, but a higher Killip class (p value = 0.03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122-292) in 2018 to 290 minutes (IQR 161-1080, p<0.001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint of heart failure, malignant arrhythmia, or death in the multivariable logistic regression model (OR 1.63, 95% CI 1.02-2.65, p value = 0.05). Conclusion: While the admission rate of AMI and STEMI in Israel remained similar during both the Covid-19 era and the corresponding period in 2018, total ischemic time extended significantly during the Covid-19 period, which translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events.