ABSTRACT
Introduction: The COVID-19 virus has caused a massive strain on medical services worldwide. Throughout 2020 and 2021, hospitals and their Intensive Care Units (ICUs) have been inundated with patients suffering from critical illness due to COVID-19, many of whom developed multiorgan failure and required prolonged ICU stays.1 Malta is a Mediterranean island with a population of 500,000 people, with one main acute general hospital (Mater Dei Hospital) with a single 20-bed ICU. This meant that the COVID-19 pandemic surge had to be managed locally by increasing ICU capacity without access to a referral network of other hospital ICUs at different phases of the pandemic or the possibility of referral to ECMO services abroad. Objectives: Establish the demographics and outcomes of all patients admitted to ICU with COVID-19 in Malta. Methods: A single centre prospective cohort study conducted in the Intensive Care Units caring for COVID-19 patients at Mater Dei Hospital, Malta. Data was collected on admission and then daily until death or discharge from ICU. Results: The COVID-19 pandemic resulted in 252 patients being admitted to ICU from March 2020 to May 2021. The peak of admissions occurred in March 2021 with a maximum of 21 admissions in a week resulting in a peak of 33 COVID-19 ICU beds being utilized. This represents 165% of the normal 20 bed ICU capacity. There were 9 readmissions, these were excluded from data analysis. All patients admitted to ICU were treated with Dexamethasone and Remdesivir, and Tocizulimab from January 2021, unless contraindicated. Overall ICU mortality was 34% and increased to 46% in those requiring mechanical ventilation. Males were responsible for 75% of admissions but gender was not associated with ICU mortality. Older patients and those with ischemic heart disease (IHD) and diabetes had a significantly increased mortality as were those patients with a higher Sequential Organ Failure Assessment (SOFA) and lower PaO2/FiO2 (P/F) on admission (Table 1). The total number of patients requiring intubation during their admission was 173 (69%) with a median time to intubation of two days [IQR 1-4]. Proning was used for 124 (69%) of the mechanically ventilated patients for a median of 2 days per patient [IQR: 1 -3], similarly muscle relaxant infusion was also used in 124 of mechanically ventilated patients (69%) for a median of three days per patient [IQR: 2 -5]. The median duration of mechanical ventilation was 11 days [IQR: 6 -22.2] with a maximum of 63 days. Tracheostomies were performed in 59 (34%) of mechanically ventilated patients with a median duration of 14.5 days intubated prior to tracheostomy [IQR: 13 -17]. The median length of stay was 11.5 days [7-23]. Conclusion: This observational study represents all COVID-19 ICU admissions that occurred in Malta from March 2020 to May 2021 in the single institution caring for these patients in the country. We have demonstrated a predominantly male, elderly admission population with an increased mortality associated with age, ischemic heart disease and diabetes. Overall ICU mortality was 34% and 46% in ventilated patients, which is comparable to that found in other national databases.2.
ABSTRACT
Introduction: The aim of the study was to determine the impact of COVID-19 pandemic on intensive care workload [1,2] at our only acute main general hospital on the island. During the pandemic surge in March 2021, our intensive care was running at 200% capacity. Mater Dei Hospital has a 20-bedded adult intensive care catering for a population of 500,000. Methods: This is a prospective cohort study conducted in the COVID- 19 Intensive Care Unit at Mater Dei Hospital, Malta. Data analysed is from March 2020 to May 2021. Data collected daily from admission until death or discharge from ICU. Results: A total of 261 patients with severe acute respiratory distress syndrome coronavirus 2 (SARS-Cov-2) required admission to our intensive care. ICU facilities required expansion into a total of 5 Intensive Care Units, therefore reaching a capacity of 44 intensive care beds during the peak month of March 2021. A maximum of 21 patients were admitted per week culminating to a total of 33 COVID-19 Intensive Care beds during the month of March 2021. A total of 179 patients (68.6%) required mechanical ventilation for a median duration of 11 days per patient. Proning was required in 124 mechanically ventilated patients (70.5%). 50 patients (20%) required CRRT with a maximum number of 7 patients per day requiring CRRT. Conclusions: COVID-19 pandemic transformed the way how we provide critical care with improved bed capacity, ICU triage and ICU devices. This study highlighted the need for more clinical guidelines and their availability for online use. This will positively impact the care of non-COVID patients. It also highlighted the need for more training of non-ICU staff to allow for surges in ICU capacity. The COVID-19 pandemic has seen Mater Dei hospital already investing in ICU personnel and equipment as this cannot be reactive to large scale events but must be a proactive planned strategy to enhance resilience of our ITU.
ABSTRACT
The severity of lung involvement on chest tomography (CT) images in COVID-19 patients may have a prognostic value. This study assesses the type, severity and frequency of the different images of lung CT in hospitalized patients with COVID-19, and the differences in clinical characteristics and in-hospital outcomes, according to the CT severity score. This represents an observational study (retrospective cohort) of hospitalized patients with COVID-19. The ISARIC-WHO form was used to collect data. The type of lung lesions, affected lobes, and total CT severity score were determined at hospital admission. The first, second and third quartiles of the total CT score were calculated to divide the sample into four equal parts (Q1, Q2, Q3 and Q4). A total of 556 patients were included, 336 men (60.4%) and 220 women (39.6%), with a mean age of 61.9 +/- 15.8 years;and 532 of them had CT scan at admission. Patients in the more severe quartiles had more days of symptoms evolution (Q1 6.4 +/- 3.5, Q2 7.9 +/- 4.1, Q3 8.2 +/- 4.1, Q4 8.1 +/- 4.4), desaturation (Q1 95.3 +/- 3.7, Q2 94.4 +/- 3.1%, Q3 91.7 +/- 4.8%, Q4 86.5 +/- 9.1%), alterations of inflammatory markers, hospital stay (Q1 6.4 +/- 2.9, Q2 7.4 +/- 4.1, Q3 9.6 +/- 5.8, Q4 13.1 +/- 10.4 days), admission to ICU (Q1-2.5%, Q2-5.8%, Q3-12.5%, Q4-49.1%), mortality (Q1-3.8%, Q2-4.5%, Q3-9.4%, Q4-33.3%), mixed CT lesions (ground glass opacity-consolidation), linear opacities, crazy-paving pattern, reverse halo sign, and bronchiectasis. The total CT score significantly correlated with leukocyte, neutrophil and lymphocyte counts, and with other inflammatory markers. Semi-quantitative evaluation of pulmonary involvement in the initial chest CT can help to establish the severity of the case and predict relevant clinical outcomes in COVID-19 patients.
ABSTRACT
Background: There is little information on the prevalence of bacterial coinfection and use of antibiotics in hospitalized CO-VID-19 patients. The present study assesses the frequency of in-hospital antibiotic prescription, the bacterial cultures im-plementation and the clinical characteristics of patients with COVID-19 according to the use of antibiotics. Methods: Ret-rospective, observational study of hospitalized patients with COVID-19. The ISARIC-WHO form was used for data col-lection. Results: 145 patients were included, 95 men and 50 women, with a mean age 63.8±16.0 years. 79/145 (54.5%) patients received antibiotics, 52/145 (35%) had samples for culture and 49/145 (33.8%) were blood cultures. Pathogenic bacteria were isolated only in 7% of the patients. The patients with antibiotics had worse oxygenation, chest tomography and inflammatory markers, more admission to ICU, deaths, and prolonged hospital stay. Conclusion: Our results do not support the initial widespread use of antibiotics in hospitalized COVID-19 patients without knowing the pathogen and its susceptibility.
ABSTRACT
Background: There is limited information about the variations of the clinical characteristics and outcomes in hospitalized patients with COVID-19 during the pandemic. No study has evaluated these changes in our region. Objective: To assess the clinical characteristics and outcomes of adult hospitalized patients with COVID-19 during the first year of the pandemic. Methods: This is a retrospective, observational study. Medical charts of hospitalized patients with COVID-19 at the Hospital Centro Médico de Caracas were reviewed to obtain information about their clinical characteristics. Results: A total of 454 patients were included, 278 men (61 %) and 176 women (39 %), with an average age of 61.97±15.95 years, previous duration of symptoms 7.38 ± 4.01 days, chest CT score 11.49±5.80, and hospital stay 8.30±5.11 days. 59.8 % of the patients had severe-critical disease, 40.2 % mild-moderate, 15.86 % were admitted to the ICU, 81.2 % were discharged and 9.5 % had died. The curve of hospitalized cases was bimodal, identifying two waves: The first between July-September 2020 (peak in August with 59 cases), the second larger and longer between December 2020 and April 2021 (peak in March 2021 with 140 cases). The length of hospital stay remained stable over one year, while mortality decreased progressively (highest value in August 2020, 26.4 % and the lowest in March 2021, 5.4 %). Conclusion: The results show the behavior of hospitalized patients with COVID-19 during a year of the pandemic in our population. It is reasonable that the decline in mortality rate is the result of changes in the age of patients, the disease severity, and provision of care during the pandemic. © 2021 Academia Nacional de Medicina. All rights reserved.
ABSTRACT
Hyperglycemia, with or without diabetes, is associated with complications in hospitalized patients with COVID-19. There is no information regarding this problem in our region. This study was aimed to compare the characteristics and in-hospital clinical course of patients with a probable diagnosis of COVID-19, with and without hyperglycemia during the hospitalization. This is a retrospective, observational study of clinical records review of hospitalized patients with COVID-19. The ISARIC-WHO form was used for data collection. Hyperglycemia was defined as a fasting value >= 140 mg/dL according to standard glycaemia targets in hospitalized patients. A total of 148 patients were included, 97 (65.5%) men and 51 (34.5%) women, with a mean age of 64.1 +/- 16.1 years;of which 42/148 (28.4%) patients reported previous diabetes, 60/148 (40.5%) patients had hyperglycemia during the hospitalization and 32/60 (53.3%) of these cases did not report previous diabetes. The patients with hyperglycemia were older, received more frequently systemic corticosteroids (96.6 vs 82.6%;p=0.01), and antibiotics (68.3 vs 44.3%;p=0.01), had worse baseline oxygenation parameters (SpO(2) 88.1 +/- 1,1.7%;vs 92.8 +/- 5.5%;p=0.02, PaO2/FiO(2), 194.4 +/- 119.7 vs 270.9 +/- 118.3;p<0.001), higher total lung severity score in the chest CT (14.9 +/- 5.7 vs 11.1 +/- 6.3;p<0.001) and higher levels of baseline inflammatory markers (CRP 6.73 +/- 3.61 vs 5.08 +/- 4.21;p<0.01, LDH 342.9 +/- 118.4 vs 296.5 +/- 161.4;p=0.01 and Ferritin 687.7 +/- 373.2 vs 542.6 +/- 395.3;p=0.01). Mortality (34.5 vs 10.7%;p<0.001) and admission to ICU (43.3 vs 7.9%;p<0.001) were higher in patients with hyperglycemia. Hyperglycemia in hospitalized patients with COVID-19 is a marker of severe disease and poor prognosis.
ABSTRACT
Objectives. To determine changes in the clinical characteristics and in-hospital outcomes of patients hospitalized for COVID-19 in a private hospital in Caracas during two years of the pandemic. Materials and Methods. Retrospective, observational study of patients hospitalized for COVID-19. We evaluated the correspondence between waves of hospital admissions and circulating variants of SARS-CoV-2 in the general population of the Capital District and Miranda state. Results. A total of 1025 patients (569 men and 456 women) were included, with a mean age of 62.9 SD: 16.2 years. Four waves of hospital admissions were identified: first (March-No-vember 2020) 150/1025 (14.6%) cases;second (December 2020 to May 2021) 415/1025 (40.5%) cases;third (June-December 2021) 344/1025 (33.6%) cases;fourth (January-February 2022) 116/1025 (11.3%) cases. The mean age was higher in the fourth wave (first: 64.0±15.7, second: 61.4±15.8, third: 62.1±16.5, and fourth wave: 68.5±16.4), while the proportion of male patients (first: 66.7%, se-cond: 58.8%, third: 50.3%, and fourth wave: 44.8%), patients with severe-critical illness (first: 65.3%, second: 57%, third: 51.7%, and fourth wave: 44.8%), in-hospital stay (first: 9.1±6.0, second: 9.0±7.3, third: 8.8±7.7, and fourth wave: 6.9±5.0 days), ICU admissions (first: 23.3%, second: 15.7%, third: 14.0%, and fourth wave: 11.2%;p=0.027) and mortality (first: 21. 8%, second: 10.7%, third: 9.1%, and fourth wave: 7.1%;p<0.001) progressively decreased over time. Conclusions. The results show lower frequency of severe cases and improvement of in-hospital outcomes in two years of the pandemic. Changes in circulating variants, improvements in disease management and vaccination are likely to have influenced these results. © 2022, Instituto Nacional de Salud. All rights reserved.