NUTRIC Score Is Not Superior to mNUTRIC Score in Prediction of Mortality of COVID-19 Patients

Objectives The NUTRIC (nutrition risk in the critically ill) score and the modified NUTRIC score are two scoring systems that show the nutritional risk status and severity of acute disease of patients. The only difference between them is the examination of interleukin-6 (IL-6) level. The aim of this study was to investigate whether or not the NUTRIC score is superior to the mNUTRIC score in the prediction of mortality of patients with COVID-19 followed up in the Intensive Care Unit (ICU). Material and Method. This retrospective study included 322 patients followed up in ICU with a diagnosis of COVID-19. A record was made of demographic data, laboratory values, clinical results, and mortality status. All the data of the patients were compared between high and low variations of the NUTRIC score and the mNUTRIC score. Results A high NUTRIC score was determined in 62 patients and a high mNUTRIC score in 86 patients. The need for invasive mechanical ventilation, the use of vasopressors in ICU, the development of acute kidney injury, and mortality rates were statistically significantly higher in the patients with high NUTRIC and high mNUTRIC scores than in those with low scores (p = 0.0001 for all). The AUC values were 0.791 for high NUTRIC score and 0.786 for high mNUTRIC score (p = 0.0001 for both). No statistically significant difference was determined between the two scoring systems. Conclusion Although the NUTRIC score was seen to be superior to the mNUTRIC score, no statistically significant difference was determined. Therefore, when IL-6 cannot be examined, the mNUTRIC score can be considered safe and effective for the prediction of mortality in COVID-19 patients.

Effects of SARS-CoV-2 Variants on Maternal Infection and Severity: A Single-Center Experience.

Background and aims Pregnant women are one of the vulnerable groups affected by COVID-19. With the mutation of the virus, the severity of the disease in this vulnerable group may vary in different waves of COVID-19 subtypes. The aim of this study is to define the demographic, clinical, laboratory, and mortality results of pregnant COVID-19 patients according to three time frames (March to December 2020, January to June 2021, and July to November 2021). Materials and methods The data of patients admitted to the ICU between March 23, 2020, and November 30, 2021, were retrospectively scanned. Pregnant patients with SARS-CoV-2 PCR test positivity or pregnant patients with COVID-19 who have a negative PCR test but symptoms of COVID-19 and radiological findings consistent with COVID-19 on thorax CT who need intensive care were included in the study. The patients were divided into three groups according to the dates when the Ministry of Health of the Republic of Turkey reported the variants of COVID-19 in Turkey. The nonvariant type was dominant in the first period (March to December 2020), alpha and beta variants were dominant in the second period (January to June 2021), and the delta variant appeared in the last period (July to November 2021). Demographic, clinical, and laboratory findings at the first admission to the ICU and mortality rates of the patients were recorded. Results PCR test was performed in all 109 patients, of whom 101 were PCR test positive. In other eight patients, despite the negative PCR test, thorax CT findings were typical of COVID-19 pneumonia, and other bacterial and viral agents were also excluded. The mean age of the patients was 30.53 years, the mean APACHE II score was 9.68, and the mean gestational age was 28.55 weeks. Around 72.5% of the patients were in the third trimester. Of the 101 PCR-positive patients, 20.2% were delta variants, 16.5% alpha or beta variants, and 63.3% were of unknown variants. Five of the patients were vaccinated. The most common symptom was dyspnea (94.5%), and the most common comorbidity was hypothyroidism (9.17%). Invasive mechanical ventilation (IMV) was needed in 44.95% of pregnant patients. The distribution of pregnant patients admitted to the ICU according to the periods March to December 2020, January to June 2021, and July to November 2021 was 16.5%, 21.1%, and 62.4%, respectively (p<0.001). Two groups of patients were compared: those that survived versus those that deceased. Variables predicting mortality were APACHE score, IMV requirement, length of stay in the ICU, prone positioning, Anakinra treatment, and ECMO (extracorporeal membrane oxygenator) requirement, which were significantly higher in the deceased group than in the living group (p<0.001, p<0.001, p=0.001, p<0.001, p<0.001, and p=0.001, respectively). There was no significant difference between the patients' age, gestational age, variants, treatments other than Anakinra, and the number of patients admitted to the ICU in the three periods (p=0.667, p=0.174, p=0.904, and p=0.605, respectively).In the multiple logistic regression analysis for mortality, high APACHE II score and IMV requirement were found as risk factors for mortality. Conclusion In the last period of delta variant predominance, pregnant COVID-19 patients were admitted to the ICU significantly more frequently than in the first two periods. Mechanical ventilation requirement and high APACHE II score were determined as risk factors for mortality.

Yoğun Bakımdaki Gebe COVID-19 Hastaların Sonuçları

Amaç: Bu çalışmanın amacı, üçüncü basamak pandemi merkezi olan Ankara Şehir Hastanesi Yoğun Bakımları’nda COVID-19 gebe hastaların dönemsel özelliklerini paylaşmak. Gereç ve Yöntem: 21 Mart 2020-30 Kasım 2021 tarihleri arasında YBÜ’ye kabul edilen gebe hastaların verileri etik kurul onamı sonrası retrospektif olarak incelendi. Hastaların demografik ve klinik özellikleri üç döneme ayrılarak (Ağustos-Aralık 2020, Ocak-Haziran 2021, Temmuz-Kasım 2021) karşılaştırıldı. Bulgular: Toplam 109 gebe COVID-19 hastanın ortalama yaşı 30,5, APACHE II 9,68, gebelik haftası 28,5 idi. Hastaların %98’i tekil gebelik, %72,5’i 3. trimesterde, %92,6’sında PCR pozitif, %20,1’i delta varyantı, 5’i aşılı idi. %94,5’i dispne ile başvurdu, %45’inin IMV gereksinimi oldu, MV süresi 8,5 gün, YBÜ yatış süresi 11,6 gün idi. Yedi hastaya ECMO uygulandı, %21’inde gebelik devam etti, %49,5’ine 250 mg steroid, %34’üne anakinra, %57,8’ine antiviral verildi. Mortalite oranı %25,6’idi. Hastaların 18’i (%16,5), AğustosAralık 2020;23’ü (%21) Ocak-Haziran 2021, 68’i (%62,4) Temmuz-Kasım 2021’de YBÜ’ye kabul edildi. Sonuç: Gebelerde de en sık başvuru semptomu COVID-19’un tipik semptomu olan dispne idi. YBÜ’ne kabul gebelik süresi ilerledikçe daha fazla idi. Uygulanan tedaviler ve pnömotoraks gibi gelişen komplikasyonlar arasında fark bulunmadı. Ancak delta varyantı son periyotta tespit edildi ve bu dönemde istatistiksel farklılık bulunmasa da YBÜ’ye kabul edilen gebelerin sayısında artış saptandı. Sonuç olarak, bu çalışmada, tüm toplumda olduğu gibi delta varyantının gebeleri de daha fazla enfekte ederek YBÜ’ye başvuru sıklığını artırdığı saptandı. (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.)

Kritik COVID-19 Hastalarında Deliryum için Haloperidol: Bir Olgu Serisi

Amaç: Haloperidol deliryum tedavisi için kullanılmaktadır. Haloperidol molekülünün mekanik ventile edilen hastalarda sitokin fırtınasını hafifleterek mortaliteyi azalttığı ve in vitro koşullarda SARS-Cov2 virüsü üzerine antiviral etkinliğe sahip olduğuna dair bazı kanıtlar yayınlandı. Bizim amacımız deliryum için haloperidol verilen kritik COVID-19 olgularını incelemektir. Gereç ve Yöntem: Üçüncü basamak bir hastanede, hastane etik kurulu izni alınarak, Mart 2020 ve Eylül 2020 tarihleri arasında bir yoğun bakım ünitesine kabul edilen, SARS-Cov2 virüsü için reverse transcription polimeraz zincir reaksiyon testi pozitif olan ve COVID-19 ile ilişkili ARDS nedeniyle mekanik ventile edilen kritik hastalar retrospektif olarak incelendi. Entübasyon öncesinde, hastanede yattığı süre içerisinde deliryum için haloperidol verilen hastalar tespit edildi. Veriler hastane medikal kayıtlarından elde edildi. Bulgular: Entübasyon öncesi haloperidol verilen yedi kritik hasta tespit edildi. Yedi hastanın beşi erkek, ikisi kadın cinsiyette idi. Hastaların yaşı medyan 60 (min: 38-maks: 96), vücut kitle indeksi medyan: 23 (min: 16-maks: 35) idi. Komorbid hastalıklar diabetes mellitus üç hastada, hipertansiyon üç hastada, koroner arter hastalığı iki hastada, konjestif kalp yetmezliği bir hastada, KOAH bir hastada ve inme bir hastada mevcut idi. APACHE II medyan 19 (min: 10-maks: 44) idi. Entübasyon öncesinde PaO2 /FiO2 oranı medyan 106 (min: 85-maks: 122) idi. Haloperidol günlük dozu medyan 3 mg/gün (min: 1-maks: 15) olarak tespit edildi. Hastanede yatış süresi medyan 24 gün (min: 7-maks: 29) ve yoğun bakım ünitesinde yatış süresi medyan 21 gün (min: 4-maks: 24) idi. Hastalardan üçü yoğun bakım ünitesinde takipleri sırasında öldü. Sonuç: Biz deliryum için haloperidol verilen kritik COVID-19 olgularını inceledik. Bu çalışma olgu serisi olduğu için sınırlı bilgi sağladı ve sebep sonuç ilişkisi kuramadık. COVID-19 hastalarında gerçekleştirilen gözlemsel bir çalışmada haloperidol verilenler ile verilmeyenler arasında ölüm açısından önemli fark olmadığı gösterildi. Bu konuda geniş kapsamlı ileri çalışmalara ihtiyaç vardır (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.)

Spondiloartropatili Olguda COVID-19’a Bağlı Şiddetli ARDS

Amaç: Spondiloartropati, eklemlerde artirit oluşturmakla birlikte tendon ve ligametleri de tutan otoimmün sistemik bir hastalıktır. Amacımız spondiloartropatili bir olguda COVID-19’a bağlı hızla ilerleyen şiddetli ARDS klinik tablosunu sunmaktır. Olgu: Nefes darlığı şikayeti nedeniyle acil servise başvuran 47 yaşında, 179 cm boyunda, 89 kg ağırlığında ve SARS-Cov-2 için aşısız kadın hastada SARS-Cov-2 PZR testi pozitif tespit edildi. Acil serviste yapılan toraks BT görüntülemesinde bilateral akciğer parankiminde dağınık yerleşimli buzlu cam dansitesi izlendi (Şekil 1). Ílk hastane başvurusundan 4 gün sonra nefes darlığının artan hastanın tekrarlanan toraks BT’de akciğer havalanma alanlarının %75’ini kaplayan yaygın buzlu cam dansitesi ve interlobüler septal kalınlaşmalar izlendi (Şekil 2). Hasta 10 yıl spondiloartropati tanısı ile non-steroidal anti-enflamatuvar ilaçlar, sülfasalazin ve kolşisin kullandı. Son bir yıldır kontrole gitmedi ve bu ilaçları kullanmadı. Sigara 22 yıl, yarım paket/gün içti. Yoğun bakım ünitesine kabul sırasında CRP (0,171 g/L), LDH (724 U/L), D-dimer (1,2 mg/L), ferritin (651 mcg/L) ve troponin I (183 ng/L) yüksek iken lenfosit sayısı (0,31x109/L) düşüktü. Steroid, anakinra, kolşisin, antikoagülan, antiplatelet, antibiyotik, antifungal, norepinefrin ve nitrik oksit tedavileri verildi. Ínvaziv mekanik ventilasyonun 25. gününde PaO2 /FiO2 oranı 83’tür. FiO2 %70 iken ölçülen arteriyel kan gazında pH 7,36, PO2 58,2 mmHg, PCO2 57,7 mmHg, HCO3 act 31,8 mmol/L, SO2 %85,4, laktat 1,6 mmol/L’dir. Sedasyon ve kas gevşetici etkisinde volüm kontrollü ventilasyonda tidal volüm 350 mL, frekans 22/ dk ve PEEP 14 cmH2O ayarlandığında ölçülen PIP 42 cm H2O, MVeksp 5,4 L/dk, Pplato 35 cmH2O, statik komplians 23 mL/cmH2O ve hesaplanan sürücü basıncı (driving pressure) 21 cmH2O’dur. Sonuç: Bu olgu hızlı ilerleyen şiddetli bir COVID-19’a bağlı ARDS kliniğine sahiptir. Ferri ve ark.’nın Ítalya’da 1.641 otoimmün sistemik hastalığa sahip hastada yaptıkları çok merkezli çalışmaya göre bu hastalarda diğer Ítalyan popülasyonuna göre COVID-19 prevalansı daha yüksektir. Otoimmün sistemik hastalığa sahip hastalarda koronavirüsten korunma tedbirlerinin sıkı bir şekilde uygulanması ve tedavi için ileriye dönük araştırmalara ihtiyaç vardır. (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.)

Anxiety and Depression in the Relatives of COVID-19 and Non-COVID-19 Intensive Care Patients During the Pandemic.

Background and aim In the literature, there is no study on the anxiety and depression status of the relatives of intensive care COVID-19 and non-COVID-19 patients during the pandemic period. In this study, we aimed to compare the risk of developing anxiety and depression in the relatives of COVID-19 and non-COVID-19 intensive care patients during the pandemic, and also to determine the factors that may cause anxiety and depression. Materials and methods Relatives of patients admitted to Ankara City Hospital COVID-19 (n=45) and non-COVID-19 (n=45) intensive care units between 15 May and 31 July 2021 were included in this prospective study. The Hospital Anxiety and Depression Scale (HADS) questionnaire was administered to the relatives of the patients within the first 48 hours of their admission to the intensive care unit. The answers were recorded and HADS, HADS-A (anxiety) and HADS-D (depression) scores were calculated accordingly. Demographics, education and marital statuses of both the patients and their relatives were recorded. Logistic regression analysis was performed to determine the factors associated with depression and anxiety. Receiver operator characteristics (ROC) curves were drawn for the factors affecting depression and anxiety, and the area under the curve values were calculated. Results Demographics, APACHE II score, and patient affiliation were similar in both groups. The mean HADS scores of the relatives of COVID-19 and non-COVID-19 patients were 24.76 and 16.04 (p<0.001). The mean HADS-A scores were 12.89 and 7.78 (p<0.001), and the mean of HADS-D scores were 11.87 and 8.27 (p=0.001). Moderate and high-risk anxiety and depression were significantly higher in relatives of COVID-19 patients (p=0.018, p=0.001, respectively). The area under curve (AUC) values were 0.727 in the ROC curve plotted for the independent risk factor Q3 responses that reduced anxiety, and 0.791 and 0.785 in the ROC curve drawn for the independent risk factor Q1 and Q3 responses that reduced the development of depression. Conclusion We found that the anxiety and depression risk of the relatives of COVID-19 patients in the intensive care unit during the pandemic period is significantly higher than the relatives of non-COVID-19 patients in the intensive care unit. In addition, regardless of the diagnosis, younger intensive care patients may increase the anxiety and depression of the relatives of the patients during the pandemic. The higher-education level of the relatives of patients was determined as a factor reducing anxiety and depression.

NUTRIC Score Is Not Superior to mNUTRIC Score in Prediction of Mortality of COVID-19 Patients.

Objectives: The NUTRIC (nutrition risk in the critically ill) score and the modified NUTRIC score are two scoring systems that show the nutritional risk status and severity of acute disease of patients. The only difference between them is the examination of interleukin-6 (IL-6) level. The aim of this study was to investigate whether or not the NUTRIC score is superior to the mNUTRIC score in the prediction of mortality of patients with COVID-19 followed up in the Intensive Care Unit (ICU). Material and Method. This retrospective study included 322 patients followed up in ICU with a diagnosis of COVID-19. A record was made of demographic data, laboratory values, clinical results, and mortality status. All the data of the patients were compared between high and low variations of the NUTRIC score and the mNUTRIC score. Results: A high NUTRIC score was determined in 62 patients and a high mNUTRIC score in 86 patients. The need for invasive mechanical ventilation, the use of vasopressors in ICU, the development of acute kidney injury, and mortality rates were statistically significantly higher in the patients with high NUTRIC and high mNUTRIC scores than in those with low scores (p = 0.0001 for all). The AUC values were 0.791 for high NUTRIC score and 0.786 for high mNUTRIC score (p = 0.0001 for both). No statistically significant difference was determined between the two scoring systems. Conclusion: Although the NUTRIC score was seen to be superior to the mNUTRIC score, no statistically significant difference was determined. Therefore, when IL-6 cannot be examined, the mNUTRIC score can be considered safe and effective for the prediction of mortality in COVID-19 patients.

Does hospitalisation of a patient in the intensive care unit cause anxiety and does restriction of visiting cause depression for the relatives of these patients during COVID-19 pandemic?

OBJECTIVES: During the pandemic, anxiety and depression may occur increasingly in the whole society. The aim of this study was to evaluate the possible cause, incidence and levels of anxiety and depression in the relatives of the patients in the intensive care unit (ICU) in accordance with the patients' SARS-CoV-2 polymerase chain reaction (PCR) result. MATERIALS AND METHOD: The study was prospectively conducted on relatives of patients admitted to tertiary intensive care units during COVID-19 pandemic. Sociodemographic characteristics of the patients and their relatives were recorded. "The Turkish version of the Hospital Anxiety and Depression Scale" was applied twice to the relatives of 120 patients to determine the symptoms of anxiety and depression in accordance with the PCR results of the patients (PCR positive n = 60, PCR negative n = 60). RESULTS: The ratios above cut-off values for anxiety and depression among relatives of the patients were 45.8% and 67.5% for the first questionnaire and 46.7% and 62.5% for the second questionnaire, respectively. The anxiety and depression in the relatives of PCR-positive patients was more frequent than the PCR negative (P < .001 for HADS-A and P = .034 for HADS-D). The prevalence of anxiety and depression was significantly higher in female relatives (P = .046 for HADS-A and P = .009 for HADS-A). There was no significant correlation between HADS and age of the patient or education of the participants. The fact that the patients were hospitalised in the ICU during the pandemic was an independent risk factor for anxiety (AUC = 0.746) while restricted visitation in the ICU was an independent risk factor for depression (AUC = 0.703). CONCLUSION: Positive PCR and female gender were associated with both anxiety and depression while hospitalisation in the ICU due to COVID-19 was an independent risk factor for anxiety and restricted visitation in the ICU is an independent risk factor for depression.

Evaluation of 17 patients with COVID-19 pneumonia treated with anakinra according to HScore, SOFA, MuLBSTA, and Brescia-COVID respiratory severity scale (BCRSS) scoring systems.

COVID-19 pandemic has been affecting the whole world by increasing morbidity and mortality rates day by day. Treatment algorithms have been attempted as parallel to the increasing experience with COVID-19. In the pathogenesis of this virus pro-inflammatory cytokine storm has been called to have the main role. The right timing should be made for treatments. We proposed IL- 1 blocking by anakinra in seventeen COVID-19 patients at high risk of worsening. Patients were assessed according to HScore, SOFA (Sequential Organ Failure Assessment Score = SOFA), MuLBSTA Score (multilobular infiltration, hypo-lymphocytosis, bacterial coinfection, smoking history, hyper-tension, and age), Brescia-COVID respiratory severity scale (BCRSS). In our study, the mortality rate was 17.6%. Consequently, 1 (5.9%) patient was receiving low-flow oxygen supply, 3 (17.6%) patients needed no longer oxygen supply and 10 (58.8%) patients were discharged from the hospital. According to the results of our study in the manner of general evaluation; we found that SOFA, MuLBSTA, and BCRSS scores were one step ahead according to HScore being insufficient to determine early phases of the disease. In our opinion, the prominent factors that emphasize the use of anakinra could be listed as comorbidity, risk, or presence of secondary infection, ongoing malignant disease. However, the other factors that enhance the use of anakinra in the situation of viremia also could be sorted as no response to full dose antivirals, antiviral side effects, or no success to antiviral treatment.

COVID-19 experience of the major pandemic response center in the capital: results of the pandemic's first month in Turkey

Background/aim: The aim of this study is to evaluate the epidemiological and clinical characteristics and parameters that determined the clinical course and prognosis of the COVID-19 patients admitted to Ankara City Hospital during the first month of the pandemic in Turkey. Materials and methods: SARS-CoV-2 PCR positive patients who were hospitalized between March 10 and April 10, 2020 were included. Results: Among 222 patients, mean age was higher in severe acute respiratory illness (SARI)/critical disease group (P < 0.001). Median time from illness onset to admission and presence of comorbidity, especially coronary artery disease and chronic obstructive pulmonary disease, were significantly higher in the SARI/critical disease group (P < 0.05). Cough and fever were the most common symptoms, while anosmia and loss of taste were observed in 8.6% and 7.7% patients, respectively. The mortality rate was 5.4%. A high neutrophil/lymphocyte ratio; low lymphocyte, monocyte, and platelet count; elevated liver enzymes; low GFR; and high levels of muscle enzymes, ferritin, and IL-6 on admission were found to be associated with SARI/critical disease (P < 0.05). Bilateral ground-glass opacity and patchy infiltration were more frequently seen in the SARI/critical disease group (P < 0.001). Patients older than 65 years had an 8-fold increased risk for development of SARI/critical disease. Conclusion: This cohort study regarding COVID-19 cases in Turkey reveals that older age, presence of comorbidity, bilateral infiltration on CT, high neutrophil/lymphocyte ratio, low monocyte and platelet count, elevated liver enzymes, low GFR, high levels of muscle enzymes, and high levels of ferritin and IL-6 on admission are predictors of SARI and severe disease.