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Objective: Coronavirus disease-2019 (COVID-19) is a newly emerging infectious disease that has become a global pandemic. This study aimed to identify the risk factors at presentation to predict intensive care unit (ICU) admissions. Materials & Methods: This retrospective observational study recruited 188 confirmed laboratory COVID-19 patients who were hospitalized in Jidhafs Maternity Hospital (JMH) from 1st June to 5th July 2020. Univariate and multivariate analyses were used to Explore risk factors associated with the increased risk of ICU admission. Results: The study revealed that older age (>60 years old) (16[38.1%], P=0.044), male gender (30 [40.0%], P=0.000) were significantly associated with the increased risk of ICU admissions. The most prevalent symptoms in admission were myalgia (13[40.6%], P=0.035), fever (39[34.2%], P=0.002) and cough (37[31.4%], P=0.032). In addition, raised serum level of alanine amino-transferase (ALAT) (34.7% vs. 20.7%, P=0.033), D-dimers (30.7% vs 12.2%, P=0.012), lactate dehydrogenase (LDH) (31.6% vs 0.0%, P=0.025) and ferritin (37.7% vs 16.7%, P=0.011) found to be important predictor of ICU admission. Conclusion: The finding indicates that older age, male gender, with increased alanine transferase (ALT), increased lactate dehydrogenase (LDH), high D-dimer and high ferritin was associated with an increased risk of ICU admissions. Identification of such factors will help to detect people who are more likely to develop severe COVID-19 disease and will help physicians to determine if patients need regular health care or ICU admission.
ABSTRACT
Lung transplantation (LTx) had been the only survival option in selected Covid-19 infected ARDS patients. We evaluated surgical outcome in such group from multi-center ECLS study. LTx patient data (n=1488)were collected from multiple institutions through the National ECLS Registry and was stratified on presence of COVID-19 infection. LTx procedure details, patient demographics and post-operative outcomes were compared between COVID-19 and non-COVID-19 patients along with pre-op ECMO vs. no ECMO COVID-19 patients using Wilcoxon rank sum test or Chi-square testing to determine distribution. Time to 30-day post-operative survival was analyzed in combination with Kaplan-Meier survival curves with log-rank testing to assess mortality in these groups of patients. P values <0.05 were considered statistically significant. Out of 1488 LTx patients, our results included a total of 34 patients infected with COVID-19 at time of LTx. When compared between covid LTx (n=34) vs. non-covid LTx (n=1,454), demographic data revealed significant differences in tracheostomy (p=0.0001), lung allocation score (p=0.0001), type of pre-op ECMO support (p=0.0001), type of ECMO support (p=0.001), conversion (p=0.006), and ventilator support time (p=0.0001);but no significant differences in gender (p=0.30), BMI (p=0.32), EVLP (p=0.078), PGD score at T24 (p=0.13), and waitlist time (p=0.75). 30-day post-operative mortality analysis showed K-M graph with no statistical significance (p=0.41) in COVID-19 and non-COVID-19 patients. In addition, we compared pre-ECMO utilized COVID-19 patients (n=21) vs. non-ECMO utilized COVID-19 patients (n=13) who were transplanted. Covid-19 infected patients when transplanted showed no significant differences in survival. Propensity score matched study indicated similar results. Selective ARDS patients may benefit from end-stage surgical options like lung transplantation. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. 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.)
ABSTRACT
Background: Lung transplantation (LTx) has been demonstrated to be a feasible therapy in patients with irreversible lung injury due to SARS-CoV-2. Aim of this retrospective study was to present our experience with LTx in SARS-CoV-2 patients. Method(s): Records of the 136 patients who underwent LTx between January 2021 and August 2022 at our institution were retrospectively reviewed. LTx was performed in SARS-CoV-2 patients who showed radiological evidence of irreversible lung failure, after failed attempts of weaning off mechanical ventilation (MV) and ECMO;showed single-organ dysfunction;were SARS-CoV-2 negative, preferably <65 years old and awake under MV and ECMO support. Graft survival was compared between COVID-19 LTx patients and contemporary patients transplanted for other indications. Median follow-up amounted to 7.6 (5.2-14.5) months. Result(s): Among the 79 patients with SARS-CoV-2 lung failure referred for LTx, 9 (11%) patients were listed, 8 of them being transplanted between January 2021 and August 2022. One patient died while on the waiting list. All were on MV and ECMO support (awake in 6 cases) for a median ECMO support time of 75 (38.5-152.8) days. Four (50%) patients were male and median age was 52 (37-57) years. All patients underwent bilateral LTx on ECMO support that was weaned off in all patients at the end of Tx. After LTx, 2 (25%) patients showed a primary graft dysfunction (PGD) score grade 3 at 72 hours and required reinstitution of veno-venous (n = 1) and veno-arterial (n = 1) ECMO support that was successfully weaned after 7 and 6 days, respectively. One patient (12.5%) required rethoracotomy for bleeding, and two (25%) patients required new hemodialysis treatment, with recovery of renal function in all patients. Median MV time amounted to 8 days (1-30), median intensive care unit stay to 19 (13-26) days, and median hospital stay to 91 (62-103) days. No patient died in-hospital. At 1-year follow-up, graft survival was 100% in SARS-CoV-2 LTx patients and 95% for patients (n = 128) transplanted for other indications (p = 0.539). Conclusion(s): Lung transplantation in highly selected SARS-CoV-2 patients yielded excellent posttransplant results. Graft survival was comparable between patients transplanted for SARS-COV-2 pneumonia and patients transplanted for other indications. A multidisciplinary approach is of paramount importance to successfully bridge these patients to transplantation and to guarantee a complete patient functional recovery after transplantation.
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Purpose: This study aims to investigate the association between vitamin D measured in serum 25 hydroxyvitamin D [25(OH)D] and outcomes of COVID-19 patients in Bahrain. This paper hypothesized that lower serum 25(OH)D concentration in COVID 19 patients is associated with longer viral clearance time (VCT) and higher risk of admission to the intensive care unit (ICU). Design/methodology/approach: This study used a retrospective cohort design of patients admitted to Salmaniya Medical Complex, Manama, Kingdom of Bahrain, from February to June 2020. This study included patients with positive, confirmed COVID-19 diagnosis made using reverse transcription-polymerase chain reaction (RT-PCR), World Health Organization diagnosis manual and local diagnostic guidelines. Primary outcome measures were: VCT measured as the time in days between the first positive RT-PCR test result and the first of two consecutive negative RT-PCR results on recovery and admission need to ICU. Findings: A total of 450 patients were analyzed;mean age was 46.4 ± 12.4 years and 349 (78%) were men. Mean 25(OH)D concentration was 41.7 ± 23.7 nmol/L for the entire sample. Severe vitamin D deficiency (<25 nmol/L) was present in 20%, mild-to-moderate deficiency (25–50 nmol/L) in 55%, insufficiency (50 to <75 nmol/L) in 18% and sufficiency (=75 nmol/L) in 7%. The mean VCT was 12.9 ± 8.2 days. Multivariate linear regression analysis showed that severe vitamin D deficiency was associated with longer VCT, with an average of three extra days after correction for age and sex (β = 3.1;p = 0.001). Multinomial regression analysis showed that vitamin D deficiency was associated with an 83% increased risk of admission to ICU after correction for age and sex (odds ratio = 1.8;p = 0.03). Originality/value: The results showed that severe vitamin D deficiency was associated with longer recovery time from COVID-19. Low serum 25(OH)D is associated with increased need for critical care in an ICU. Large-scale randomized controlled trials are necessary to further investigate the complex association between vitamin D and COVID-19 infection. © 2021, Emerald Publishing Limited.
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Viral infections have gained great attention following the rapid emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic around the globe. Even with the continuous research on developing vaccines and antiviral agents against various viral infections, no specific treatment or vaccine has been approved for many enteric or respiratory viral infections;in addition, the efficiency of currently available treatments is still limited. One of the most reliable and recommended strategies to control viral infections is prevention. Recently, intense studies are focusing on a promising approach for treating/preventing various viral infections using probiotics. As per the World Health Organization (WHO), probiotics can be defined as “live microorganisms which, when administered in adequate amount, confer a health benefit to the host.” The use of probiotics is a simple, cost-effective, and safe strategy to prevent viral infections, specifically;respiratory tract and intestinal ones, by different means such as stimulating the host’s immune response or modulating gut microbiota. In this rapid review, we emphasize the protective effects of probiotics against viral infections and proposed mechanisms for protection that might offer a novel and cost-effective treatment against current and newly discovered viruses like SARS-CoV-2. © 2020 Jehan Abdul-Sattar Salman, Nibras Nazar Mahmood, Ban Oday Abdulsattar, Hussein Adil Abid.