ABSTRACT
Background: Iran was one of the first countries to become an epicenter of the coronavirus disease 2019 (COVID-19) epidemic. However, there is a dearth of data on the outcomes of COVID-19 and predictors of death in intensive care units (ICUs) in Iran. We collected extensive data from patients admitted to the ICUs of the one of the tertiary referral hospitals in Tehran, Iran, to investigate the predictors of ICU mortality.Methods: The study population included 290 COVID-19 patients who were consecutively admitted to the ICUs of the Sina hospital from May 5, 2021, to December 6, 2021, a period that included the peak of the epidemic of the delta (delta) variant. Demographic data, history of prior chronic diseases, laboratory data (including markers of inflammation), radiologic data, and medication data were collected. Results: Of the 290 patients admitted to the ICUs, 187 (64.5%) died and 103 (35.5%) survived. One hundred forty-one (141, 48.6%) were men, and the median age (10th percentile, 90th percentile) was 60 (41, 80). Using logistic regression models, older age, history of hypertension, high levels of inflammatory markers, low oxygen saturation, substantial lung involvement in computed tomography (CT) scans, and gravity of the disease as indicated by the WHO 8-point ordinal scale were primary predictors of mortality at ICU. The use of remdesivir and imatinib was associated with a statistically non-significant reduction in mortality. The use of tocilizumab had almost no effect on mortality.Conclusion: The findings are consistent with and add to the currently existing international literature. The findings may be used to predict risk of mortality from COVID-19 and provide some guidance on potential treatments
ABSTRACT
Objective: The present study was conducted to compare mechanically ventilated patients with and without COVID-19 in terms of hemodynamic instability using cardiovascular indicators. Methods: This prospective cohort study assigned intubated and mechanically ventilated patients to two groups, i.e. with COVID-19 and without COVID-19. The hemodynamic parameters measured and compared between the two groups on the first day of ICU admission and the following four consecutive days using an ultrasonic cardiac output monitor (USCOM) included cardiac output (CO), systemic vascular resistance (SVR), stroke volume (SV), flow time corrected (FTc), minute distance (MD) and potential kinetic energy (PKE). Results: Forty-three patients (males: 62.7%) were assigned to the COVID-19 group and 40 (males: 64.1%) to the one without COVID-19. Insignificant differences were observed between the two groups at baseline in terms of the mean homodynamic variables measured using the USCOM (P>0.05). The mean CO increased (P=0.020), the mean SVR insignificantly changed (P=0.267), the mean MD increased (P=0.005) and PKE decreased (P=0.066) in the COVID-19 group during the five days of evaluation. In the same period, the mean CO insignificantly changed (P=0.937), the mean SVR increased (P=0.028) and changes in MD (P=0.808) and PKE (P=0.539) were insignificant in the group without COVID-19. The two groups were not significantly different in terms of the other homodynamic parameters during the follow-up (P>0.05). Conclusion: The five-day changes in the USCOM-measured homodynamic parameters were lower in the group without COVID-19 compared to in that with COVID-19. In the group without COVID-19, no statistically-significant differences were observed between the mean follow-up values of the variables, excluding SVR, and their baseline values.
ABSTRACT
Introduction: LipoxinA4 (LXA4) is an anti-inflammatory biomarker that participates in the active process of inflammation resolution which is suggested to be beneficial in infectious and inflammatory diseases like the coronavirus disease 2019 (COVID-19). Objectives: This study aimed to determine early changes of LXA4 levels in the hospitalized patients with confirmed COVID-19 following the clinical management as well as its correlation with common used inflammatory markers, including Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), and ferritin. Methods: Thirty-one adult hospitalized patients with the non-severe COVID-19 were included. LXA4, ESR, and CRP serum levels were collected on the first day of hospitalization, and LXA4 levels were measured 48-72 h later as well. Moreover, the maximum serum ferritin level during the five days of following patients was collected. Results: The mean age of patients was 61.9 ± 17 years, and the male to female ratio was 18:13. LXA4 levels were significantly increased at 48-72 h compared to the baseline concentrations (9.9 ± 0.7 vs. 21.7 ± 15.1 ng/L;P < 0.05). The mean baseline concentrations of CRP and ESR and the mean maximum concentration of ferritin were 74.7 ± 57.3 mg/L, 55.7 ± 34.4 mm/h, and 568.7 ± 530 ng/mL, respectively. Besides, CRP and ESR levels at the time of admission and maximum ferritin levels during the hospitalization were positively correlated to an increase of LXA4 levels (R = 0.499, 0.535, 0.398;P = 0.007, 0.005, 0.043, respectively). Conclusion: LXA4 may be a valuable marker to assess the treatment response compared to ESR, CRP, and ferritin in hospitalized patients with COVID-19. Furthermore, LXA4 could be considered a potential treatment option in inflammatory conditions. Further studies are necessary to clarify LXA4 role in COVID-19 pathogenesis, as well as the balance between such pro-resolving mediators and inflammatory parameters.