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INTRODUCTION: Coronavirus disease 2019 (Covid-19) represents viral pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In non-COVID ARDS patients, high driving pressure (DP = Plateau pressure - PEEP) has been associated with higher mortality. Pathophysiological features of COVID ARDS have been considered different from non-COVID ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. The objective of this study is to evaluate the effect of DP on mortality in intubated COVID-19 ARDS patients. METHOD(S): All data were retrospectively collected from EHR of COVID-19 patients admitted to our ICU in2020. COVID ARDS patients in our institution are managed based on ARDS management guidelines that include lung protective ventilation strategy, PEEP protocol, and prone positioning for persistent PaO2/FiO2 (P/F) ratio < 150. Average P/F, Plateau pressure (PP), DP, and SOFA scores were collected and calculated on first three days of mechanical ventilation and correlated with mortality. RESULT(S): A total of 46 patients intubated with COVID-19 ARDS were included, with 25 survivors and 21 nonsurvivors (ICU mortality rate 46%). Compared to Non-survivor group, the survivor group had similar age (60 +/-12 vs 66 +/-12, p = 0.1), similar P/F ratios(D1: 147 +/-96 vs 136 +/-98, p = 0.7;D3: 136 +/-88 vs 128 +/-74, p = 0.7), similar PP (D1: 23 +/-7 vs 25 +/-6, p = 0.2;D2: 24 +/-6 vs 26 +/-7, p = 0.2;D3: 28 +/-7 vs 29 +/-7, p = 0.7), less number of comorbidities (1.7 +/-1.6 vs 3.2 +/-2.8, p = 0.03), better SOFA score change (SOFA D3 minus D1: 0.4 +/-0.5 vs 1.7 +/-1.7, p = 0.0006), and significantly less DP (D1: 11 +/-5 vs 15 +/-4, p = 0.006;D2: 12 +/-3 vs 15 +/-6, p = 0.01;D3: 14 +/-5 vs 19 +/-8, p = 0.02). CONCLUSION(S): Similar to other forms of ARDS, low driving pressure (less than 15 cmH2O) in COVID-19 ARDS is associated with lower mortality. These findings should be investigated in large multicenter prospective studies.
ABSTRACT
INTRODUCTION: Coronavirus disease 2019 (Covid-19) represents viral pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In ARDS patients, positive fluid balance has been associated with prolonged mechanical ventilation, longer length of stay, and higher mortality. As a result, restrictive fluid strategies improved oxygenation and reduced duration of mechanical ventilation. Optimal fluid management strategy for invasively ventilated COVID-19 patients is lacking. The objective of this study is to evaluate the effect of fluid balance on need for proning and successful liberation of invasive mechanical ventilation (MV) in patients with COVID-19 ARDS. METHOD(S): All data were retrospectively collected from EHR of COVID-19 patients admitted to our ICU. COVID ARDS patients in our institution are managed based on ARDS management guidelines that include lung protective ventilation strategy, PEEP protocol, and prone positioning for persistent PaO2/FiO2 (P/F) ratio < 150. Fluid balance in ml was calculated on Day 1 (F1) and Day 7 (F7) of ICU admission. Groups were divided into those successfully liberated (L-group) and those unable to be liberated from MV (U-group). RESULT(S): A total of 57 patients intubated with COVID-19 ARDS were included, with 29 in the L-group and 28 in the U-group. Compared to U-group, L-group had similar age (64 +/- 13 vs 64 +/- 13, p = 1.0), number of comorbidities (2.3 +/- 2.2 vs 2.7 +/- 2.5, p = 0.5), P/F ratio on day 1 (D1, 144 +/- 110 vs 130 +/- 95, p = 0.6), D1 SOFA score (6.4 +/- 4.5 vs 5.9 +/- 4.3, p = 0.7), and F1 (434 +/- 1106 vs 413 +/- 1301, p = 0.9). F7 was significantly less for L-group than U-group (290 +/- 2500 vs 2000 +/- 4000, p = 0.05). [F7 - F1] was also significantly less for L-group compared to U-group (- 144 +/- 1400 vs 1600 +/- 2800, p = 0.004). There was less need for proning (38 % vs 72 %, p = 0.01), and lower mortality (24% vs 86 %, p < 0.001) in the L-group compared to the U-group. CONCLUSION(S): In a cohort of invasively ventilated patients with COVID-19 ARDS, a lower cumulative fluid balance was associated with less need for proning and more successful liberation of MV, indicating that restricted fluid management in these patients may be beneficial. These findings should be investigated in large multicenter prospective studies.
ABSTRACT
INTRODUCTION: The novel coronavirus disease (COVID-19), is an infectious disease caused by the newly discovered virus (SARS-CoV-2). A few COVID-19 patients can have severe disease that is life-threatening and require ICU admission. The objective of this study is to compare the performance of APACHE IV (Acute Physiology and Chronic Health Evaluation), MEWS (Modified Early Warning Score), and mSOFA (Modified Sequential Organ Failure Assessment) in predicting mortality in COVID-19 patients admitted to the ICU. METHODS: All data ware retrospectively collected from electronic health records of COVID-19 patients on day 1 of admission to our ICU between March 1st and May 30th, 2020. Data was used to calculate APACHE IV, MEWS, and mSOFA for each patient. Student t test was used to compare means. The C statistic was calculated as a measure of the overall strength of prediction for both CSS and APACHE IV. Receiver-operating characteristic (ROC) curves were used to assess the mortality predictions. RESULTS: A total of 79 patients with COVID-19 were included, with 50 survivors (S) and 29 nonsurvivors (NS);mortality rate of 36.7 %. Compared to S, NS were older (70 ± 14 vs 61 ± 14, p = 0.0001), had higher APACHE IV scores (79 ± 37 vs 51 ± 23, p = 0.0001), similar MEWS (3.2 ± 2.2 vs 2.9 ± 1.9, p = 0.4), and higher mSOFA (4.3 ± 3.7 vs 3.0 ± 2.6, p = 0.01). Estimating the ROC area under the curve (AUC) showed that APACHE IV was a significantly better predictor of hospital mortality compared to MEWS or mSOFA (AUC = 0.78 ± 0.05 for APACHE IV compared to 0.60 ± 0.04 for MEWS [p < 0.0001], and compared to 0.66 +/- 0.04 for mSOFA [p = 0.0001]). CONCLUSIONS: APACHE IV was a better predictor of mortality than either MEWS or mSOFA in patients with COVID-19 admitted to ICU. These findings should be further investigated in large multicenter prospective studies.
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INTRODUCTION: The novel coronavirus disease (COVID-19), is an infectious disease caused by the newly discovered virus (SARS-CoV-2). Statin therapy might be considered for patients with COVID-19 based on following rationales. First, one of the greatest risk factors for severe COVID-19 disease is underlying cardiovascular disease. Several cardiovascular complications of COVID-19 infection have been described and statins might be beneficial in preventing some of these. Secondly, there is a hypothesis that statins may protect innate immune responses to viral respiratory infections (including to SARS-CoV) through inhibiting the MYD88 pathway. Thirdly, statins are generally considered 'safe'. Some COVID-19 patients have severe disease that is life-threatening and requires ICU admission. The objective of this study was to compare outcomes of patients admitted to the ICU with COVID-19 who were on chronic statins (S Group) vs those who never were on statins (NS group). METHODS: All data ware retrospectively collected from electronic health records of COVID-19 patients admitted to our ICU between March 1st and May 30th, 2020. Data was used to calculate APACHE IV (Acute Physiology and Chronic Health Evaluation), MEWS (Modified Early Warning Score), and mSOFA (Modified Sequential Organ Failure Assessment) on day 1 of ICU admission for each patient's baseline characteristics. Student t test was used to compare means. Outcomes included ICU length of stay in days (ICU LOS), hospital length of stay in days (hospital LOS), ICU mortality, and hospital mortality. RESULTS: A total of 74 patients with COVID-19 were included, with 35 in the S group and 39 in the NS group. Compared to NS group, S group had similar APACHE IV scores (61 ± 28 vs 62 ± 35, p = 0.9), similar MEWS (2.6 ± 1.7 vs 3.3 ± 2.3, p = 0.2), and similar mSOFA (3.6 ± 2.3 vs 3.7 ± 3.7, p = 0.9). There were no statistically significant differences in ICU LOS (13 +/- 15 vs 10 +/- 11, p = 0.4), hospital LOS (19 +/- 16 vs 16 +/- 16, p = 0.4), ICU mortality (37% vs 31 %, p = 0.6), or hospital mortality (40% vs 36 %, p = 0.7). CONCLUSIONS: In a single center study, statins were not associated with protective effect against COVID-19 patients that required ICU admission. Statins for COVID-19 should be investigated in prospective studies.
ABSTRACT
INTRODUCTION: The novel coronavirus disease (COVID-19), is an infectious disease caused by the newly discovered virus (SARS-CoV-2). A few COVID-19 patients can have severe disease that is life-threatening and require ICU admission. The objectives of this study are to evaluate the performance of a novel scoring system in predicting mortality in COVID-19 patients admitted to the ICU, and to compare outcome prediction to APACHE IV. METHODS: A novel scoring system (COVID-19 severity score, CSS) is calculated from neutrophil/lymphocyte ratio (NLR), CRP, Ferritin levels (F), and D-dimer levels (D) as follows: CSS = (NLR X CRP X F X D)/10,000. All data ware retrospectively collected from electronic health records of COVID-19 patients on day 1 of admission to our ICU between March 1st and May 30th, 2020. Student t test was used to compare means. The C statistic was calculated as a measure of the overall strength of prediction for both CSS and APACHE IV. Receiver-operating characteristic (ROC) curves were used to assess the mortality predictions. RESULTS: A total of 40 patients with COVID-19 were included, with 27 survivors (S) and 13 nonsurvivors (NS);ICU mortality rate of 32.5 %. Compared to S, NS were older (68 ± 19 vs 61 ± 14, p = 0.07), had higher APACHE IV scores (75 ± 37 vs 56 ± 28, p = 0.01), higher NLR (8.8 ± 8.6 vs 3.8 ± 2.2, p = 0.0006), lower CRP (75 ± 37 vs 99 ± 61, p = 0.04), similar F (3300 ± 5200 vs 2500 ± 2100, p = 0.4), similar D (2.8 ± 1.2 vs 2.7 ± 1.3, p = 0.7), and higher CSS (520 ± 1000 vs 147 ± 120, p = 0.03). Estimating the ROC area under the curve (AUC) showed that CSS was a significantly better predictor of hospital mortality compared to APACHE IV (AUC = 0.75 ± 0.05 for CSS compared to 0.70 ± 0.05 for APACHE IV (p < 0.0001). CONCLUSIONS: CSS was a strong predictor of mortality in patients with COVID-19 admitted to ICU. These findings should be further investigated in large multicenter prospective studies.
ABSTRACT
INTRODUCTION: The novel coronavirus disease (COVID-19), is an infectious disease caused by the newly discovered virus (SARS-CoV-2). Some patients with COVID-19 develop severe disease that is life-threatening and leads to ICU admission. Diabetes is a proposed risk factor in development of SARS-CoV-2 infection and might be associated with the prognosis of COVID-19. The objective of this study was to evaluate the relationship between elevated glycosylated hemoglobin (HbA1C) levels, and its association in COVID-19 patients. METHODS: All data ware retrospectively collected from electronic health records of COVID-19 patients on day 1 of admission to our ICUs between March 1st and May 30th, 2020. Data were used to investigate the relationship between elevated HbA1C levels, hospital and ICU length of stay (LOS), and ventilator free days. RESULTS: Out of 79 patients with COVID-19, a total of 29 patients with HbA1C results were included. They were divided into two groups: group A with HbA1C level greater or equal to 6%, and group B with HbA1C less than 6%. A one side t test was preformed to analyze if these groups of patients had a significantly difference in vent free days, ICU LOS and hospital LOS. A significant difference was found in all 3 categories. Compared with group B patients, group A patients had significantly longer hospital LOS (22.83 ± 17.6, p < 0.05), ICU LOS (16.48 ± 15.7, p < 0.05) and shorter ventilator free days (6.56 ± 10.1, p < 0.05). CONCLUSIONS: Elevated HbA1C level greater than or equal to 6% is significantly associated with longer hospital, ICU LOS, and shorter ventilator free days in COVID-19 patients. These findings should be further investigated in large multicenter prospective studies.