Factors affecting post-operative complications and mortality in surgical patients with and without COVID-19.

OBJECTIVE: The objective of the study was to evaluate the effect of COVID-19 on the outcomes of surgical patients and the factors associated with postoperative complications and mortality. METHODS: The study included hospitalized patients with similar demographic and clinical features, who underwent similar surgical operations with a positive polymerase chain reaction test for SARS CoV-2 before or within days following the surgery (COVID-19 group) and a control group was formed of patients who tested negative for COVID-19. The two groups were compared in terms of demographic, clinical, and laboratory data, the presence of pneumonia, complications, and 30-day post-operative mortality. RESULTS: The diagnosis for COVID-19 increased the risk of complications and mortality. Age, CRP, D-dimer, ASA Grade 3-4, > 2 comorbidities, and pneumonia were determined to be factors increasing the risk of complications. Age, CRP, > 2 comorbidities, emergency operations, and pneumonia were determined to increase the risk of mortality. CONCLUSION: As patients with peri/post-operative COVID-19 positivity might be at increased risk of postoperative complications and mortality, emergency surgery in infected cases should be delayed in appropriate cases.

OBJETIVO: Nos propusimos evaluar el efecto de la COVID-19 en los resultados de los pacientes quirúrgicos y los factores relacionados con las complicaciones postoperatorias y la mortalidad. MÉTODOS: Se incluyeron los pacientes hospitalizados sometidos a operaciones quirúrgicas similares con características demográficas y clínicas similares con una prueba de reacción en cadena de la polimerasa positiva para el CoV-2 del SARS antes/en los días siguientes a la cirugía (grupo COVID-19) y los controles negativos. Los dos grupos se compararon en términos demográficos, clínicos y de laboratorio de la presencia de neumonía, las complicaciones y la mortalidad a los 30 días del postoperatorio. RESULTADOS: El diagnóstico de COVID-19 aumentó el riesgo de complicaciones y mortalidad. La edad, la CRP, el Dímero D, el grado 3-4 de la ASA, tener más de 2 comorbilidades y neumonía se relacionaron con un mayor riesgo de complicaciones. Mientras que la edad, la PCR, tener más de dos comorbilidades, las operaciones de urgencia y la neumonía se relacionaron con un mayor riesgo de mortalidad. CONCLUSIONES: Los pacientes con COVID-19 pre/postoperatorio podrían tener un mayor riesgo de complicaciones postoperatorias y de mortalidad, por lo que las cirugías de urgencia en casos infectados podrían retrasarse en los casos adecuados.

The association between QT interval changes and the treatment protocols of COVID-19 patients.

OBJECTIVE: This study aimed to investigate the QT, QTc, and QTc dispersion changes that may occur with the use of hydroxychloroquine (HCQ), favipiravir, and moxifloxacin in combination or alone in COVID 19 patients. METHODS: This study was retrospectively conducted on 193 inpatients diagnosed with COVID-19. We divided the patients into four separate groups due to their medications as, group-1: favipiravir, group-2: favipiravir + HCQ, group-3: favipiravir + moxifloxacin, and group-4: favipiravir + moxifloxacin + HCQ. We recorded their pre and post-treatment QT parameters of each group and evaluated the changes of these parameters with the SPSS statistical program. RESULTS: The mean age of the patients was 63.1±17.7. In group 1 and 2, although there were slight changes in QT parameters, these results were not statistically significant. In group 3, significant increases in QT and QTc dispersion occurred (p=0.005 and p=0.018). In the 4th group where the triple therapy was applied, there was a significant increase only in the QTc values (p=0.027). When we compared the changes of QT parameters for each group, a significant difference was found in ΔQTc dispersion, and post hoc analysis showed that it was due to changes in the third group (p=0.047). CONCLUSION: We thought that, if there is a COVID-19 infection with an additional bacterial infection, and if there is a need of using moxifloxacin alone or together with HCQ, additional risk factors that may cause QT interval prolongation should be reviewed and ECG monitoring of the patients should be performed during the treatment period.

Tracheal Stenosis After Prolonged Intubation Due to COVID-19.

OBJECTIVES: The authors aimed to evaluate the characteristics and management outcomes of patients who developed tracheal stenosis after invasive mechanical ventilation (IMV) due to COVID-19. DESIGN, SETTING, AND PARTICIPANTS: The data of 7 patients with tracheal stenosis and 201 patients without tracheal stenosis after IMV due to COVID-19 between March 2020 and October 2021 were retrospectively analyzed. INTERVENTIONS: Flexible bronchoscopy was performed for the diagnosis of tracheal stenosis and the evaluation of the treatment's effectiveness, and rigid bronchoscopy was applied for the dilatation of tracheal stenosis. MEASUREMENTS AND MAIN RESULTS: In the follow-up period, tracheal stenosis was observed in 7 of 208 patients (2 women, 5 men; 3.3%). The patients were divided into 2 groups as patients with tracheal stenosis (n = 7) and patients without tracheal stenosis (n = 201). There were no statistically significant differences between the 2 groups in terms of age, sex, body mass index, and comorbidities (p > 0.05). The mean duration of IMV of the patients with tracheal stenosis was longer than patients without tracheal stenosis (27.9 ± 13 v 11.2 ± 9 days, p < 0.0001, respectively). Three (43%) of the stenoses were web-like and 4 (57%) of them were complex-type stenosis. The mean length of the stenoses was 1.81 ± 0.82 cm. Three of the patients were treated successfully with bronchoscopic dilatation, and 4 of them were treated with tracheal resection. CONCLUSIONS: Tracheal stenosis developed in 7 of 208 (3.3%) patients with COVID-19 who were treated with IMV. The most important characteristic of patients with tracheal stenosis was prolonged IMV support.

Patients with hypertension hospitalized with COVID-19 pneumonia using angiotensinconverting enzyme inhibitors and angiotensin II receptor blockers or other antihypertensives: retrospective analysis of 435 patients.

BACKGROUND: The angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARBs) are widely used for the treatment of hypertension (HT). Whether the use of these drugs increases the infectivity of novel coronavirus and results in an additional risk for morbidity and mortality of COVID-19 is a matter of interest. OBJECTIVES: Assess the effect of ACEI/ARBs compared with other hypertensives on the clinical course and outcome in COVID-19 pneumonia. DESIGN: Retrospective. SETTINGS: Tertiary care hospital. PATIENTS AND METHODS: We collected data on adult inpatients with COVID-19 pneumonia using ACEI/ARBs versus other antihypertensives between 15 March 2020, and 15 February 2021. MAIN OUTCOME MEASURES: Severity, clinical course, mortality, and time to PCR negativity between patients using ACEI/ARBs and other antihypertensives. SAMPLE SIZE: 435 RESULTS: ACEI/ARBs were used by 203 patients (46.6%) (median age: 71 [41-94] years), while 232 patients (53.4%) were using other antihypertensives (median age: 69 [22-93] years, P=.645 vs age of ACEI/ARB users). There were no statistically significant differences between the ACEI/ARBs users and non-users in the number of patients admitted to intensive care (65 cases [32%] vs. 74 cases [31.9%], P=.978), the median duration of stay in hospital (8 [1-54] days vs.7 [1-55] days, P=.806) the median duration of ICU stay (8 [1-40] days vs. 6 [1-25] days), and the mortality rate (48 cases [23.6%] vs. 61 [26.3%], P=.525). While the median days before transfer to the ICU was shorter in ACE/ARBI non-users (2 [1-15] days vs. 3 [1-21] days, P=.02), the difference was not important clinically. The median time to PCR negativity was similar in ACEI/ARBs users and non-users (13 [7-34] days for users and 13 [5-45] days for non-users), (P=.083). CONCLUSIONS: ACEI/ARB use is probably unrelated to poor prognosis in COVID-19 pneumonia inpatients. ACEI/ARBs did not prolong the time to PCR negativity. We conclude that using ACEI/ARBs probably does not increase the infectivity of SARS-CoV-2. LIMITATIONS: Pharmacological therapies were not discussed in detail. The use of corticosteroids may affect the time to PCR negativity. We could not analyze the effect of obesity because of a lack of data. CONFLICT OF INTEREST: None.

COVID-19 and thrombosis: Prophylaxis and management.

COVID-19 emerged in Wuhan, China in late December 2019, and WHO declared it a pandemic on March 11, 2020. The disease has a wide spectrum ranging from asymptomatic or mild disease to ARDS and death. There have been over 83.9 million cases with 1.8 million deaths worldwide. COVIDassociated coagulopathy appears to be an entity responsible for deaths. Thromboprophylaxis is recommended in patients with COVID-19 to prevent arterial and venous thromboembolism. Low molecular weight heparin such as enoxaparin is often recommended. However, there is still no consensus regarding the treatment dose and duration. The purpose of this review was to observe the pathogenesis of thromboembolic events in COVID-19, current thromboprophylaxis regimens, treatment dosage and duration with guidelines of international scientific institutions.

Mean Platelet Volume as an Early Predictor for The Complication of Coronavirus Disease 19

INTRODUCTION: Although several studies have been conducted on the association of mean platelet volume (MPV) with the diagnosis, morbidity, and mortality of coronavirus disease 19 (COVID-19) patients, the results were contradictory. We aimed to investigate the effects of MPV on hospitalization and mortality with a significant number of patients. METHODS: This multicenter study was carried out retrospectively on 9.487 patients. The demographic information and laboratory parameters of the patients were obtained from their medical records in the hospital. Analyses were performed using Statistical Package for the Social Sciences (SPSS) version 22.0 for Windows. RESULTS: In total, there were 806 intensive care unit (ICU) patients, in addition to 8.681 non-ICU patients. The mean age of patients in ICU was significantly higher than non-ICU (71.25±13.42 vs. 56.17±16.59;p<0.001). MPV values at admission and max MPV values during the period of hospitalization were significantly higher in patients followed in the ICU (p<0.05). MPVfirst, MPVlast, ΔMPVlast-first, and ΔMPV% values were significantly higher in non-survivor group than the survived patients. As a result of receiver-operating characteristic analysis, the risk of mortality was determined to be 5.15 fold greater in people with MPVlast ≥10.05 fl. (ODDS ratio: 5.15 95% CI: 4.374–6.067). The patient has a 4.62 fold risk of death after a 2.18% increase of arrival MPV value (ODDS ratio: 4.62, 95% CI: 3.455-6.203). DISCUSSION AND CONCLUSION: We thought that MPV and MPV changes during hospitalization may be a powerful predictor of mortality in patients with COVID-19.Alternate abstract: GÍRÍŞ ve AMAÇ: COVID-19 hastanın teşhisi, morbidite ve mortalitesi ile MPV ilişkisi üzerine yürütülmüş çalışmalar olmasına rağmen, sonuçlar çelişkilidir. Bu çalışmada belirgin sayıda hasta ile MPV'nin hastanede yatış süresi ve mortalite üzerindeki etkilerini araştırmayı amaçladık. YÖNTEM ve GEREÇLER: Bu çok merkezli çalışma, 9.487 hasta üzerinde retrospektif olarak gerçekleştirildi. Hastaların demografik bilgileri ve laboratuvar parametreleri hastanedeki tıbbi kayıtlarından elde edildi. Analizler, Windows (SPSS) 22.0 sürümü kullanılarak yapıldı. BULGULAR: Çalışmaya, 8.681 yoğun bakım ünitesi (YBÜ) dışında takip edilen hastaya ek olarak 806 yoğun bakım hastası dâhil edildi. YBÜ'de takip edilen hastaların yaş ortalaması (YBÜ) dışında takip edilen hastalara göre anlamlı derecede yüksekti (71,25 ± 13,42'ye karşı 56,17 ± 16,59;p <0,001). Başvuru anındaki ortalama trombosit hacmi (Mean Platelet Volume: MPV) değerleri ve yatış süresindeki maksimum MPV değerleri yoğun bakım ünitesinde takip edilen hastalarda anlamlı olarak yüksekti (p <0.05). Hayatını kaybeden grupta MPVilk, MPVson, ΔMPVson-ilk ve ΔMPV% değerleri sağ kalan hastalara göre anlamlı olarak daha yüksekti. ROC analizi sonucunda MPVson ≥ 10.05 fl olan kişilerde ölüm riskinin 5.15 kat daha fazla olduğu belirlendi (ODDS oranı: 5.15 %95 CI: 4.374-6.067). Hastanın, hastaneye ilk geliş MPV değerinde %2.18'in üzerindeki artışlarda ölüm riskinin 4.62 kat arttığı görüldü (ODDS oranı: 4.62,%95 CI: 3.455-6.203). TARTIŞMA ve SONUÇ: Sonuç olarak, hastanede yatış sırasındaki MPV ve MPV değişikliklerinin COVID-19 hastalarında mortalitenin güçlü bir belirleyicisi olabileceği düşünüldü.

Evaluation of the effectiveness and safety of adding ivermectin to treatment in severe COVID-19 patients.

BACKGROUND AND OBJECTIVES: An effective treatment option is not yet available for SARS-CoV2, which causes the COVID-19 pandemic and whose effects are felt more and more every day. Ivermectin is among the drugs whose effectiveness in treatment has been investigated. In this study; it was aimed to investigate the presence of gene mutations that alter ivermectin metabolism and cause toxic effects in patients with severe COVID-19 pneumonia, and to evaluate the effectiveness and safety of ivermectin use in the treatment of patients without mutation. MATERIALS AND METHODS: Patients with severe COVID19 pneumonia were included in the study, which was planned as a prospective, randomized, controlled, single-blind phase 3 study. Two groups, the study group and the control group, took part in the study. Ivermectin 200 mcg/kg/day for 5 days in the form of a solution prepared for enteral use added to the reference treatment protocol -hydroxychloroquine + favipiravir + azithromycin- of patients included in the study group. Patients in the control group were given only reference treatment with 3 other drugs without ivermectin. The presence of mutations was investigated by performing sequence analysis in the mdr1/abcab1 gene with the Sanger method in patients included in the study group according to randomization. Patients with mutations were excluded from the study and ivermectin treatment was not continued. Patients were followed for 5 days after treatment. At the end of the treatment and follow-up period, clinical response and changes in laboratory parameters were evaluated. RESULTS: A total of 66 patients, 36 in the study group and 30 in the control group were included in the study. Mutations affecting ivermectin metabolism was detected in genetic tests of six (16.7%) patients in the study group and they were excluded from the study. At the end of the 5-day follow-up period, the rate of clinical improvement was 73.3% (22/30) in the study group and was 53.3% (16/30) in the control group (p = 0.10). At the end of the study, mortality developed in 6 patients (20%) in the study group and in 9 (30%) patients in the control group (p = 0.37). At the end of the follow-up period, the average peripheral capillary oxygen saturation (SpO2) values of the study and control groups were found to be 93.5 and 93.0%, respectively. Partial pressure of oxygen (PaO2)/FiO2 ratios were determined as 236.3 ± 85.7 and 220.8 ± 127.3 in the study and control groups, respectively. While the blood lymphocyte count was higher in the study group compared to the control group (1698 ± 1438 and 1256 ± 710, respectively) at the end of the follow-up period (p = 0.24); reduction in serum C-reactive protein (CRP), ferritin and D-dimer levels was more pronounced in the study group (p = 0.02, p = 0.005 and p = 0.03, respectively). CONCLUSIONS: According to the findings obtained, ivermectin can provide an increase in clinical recovery, improvement in prognostic laboratory parameters and a decrease in mortality rates even when used in patients with severe COVID-19. Consequently, ivermectin should be considered as an alternative drug that can be used in the treatment of COVID-19 disease or as an additional option to existing protocols.

Retrospective analysis of severe COVID-19 pneumonia patients treated with lopinavir/ritonavir: A comparison with survivor and non-survivor patients.

BACKGROUND: Currently there is no proven medical treatment for COVID-19. We aimed to determine the factors affecting mortality and changes in clinical and laboratory findings in patients with severe COVID-19 pneumonia treated with lopinavir/ritonavir (Lpv/r). METHODS: Data of survivor and non-survivor severe COVID-19 pneumonia patients treated with Lpv/r were analysed retrospectively. RESULTS: A total of 73 patients, 26 (35.6%) females and 47 (64.4%) males were included in the study. The mean age of non-survivor and survivor patients was 64.3 ± 12 and 52.6 ± 12.2, respectively (p < 0.0001). Frequency of smoking and comorbid diseases was higher in non-survivor patients than in survivor patients (37% vs. 8.7% p = 0.003 and 92.6% vs. 28.3%, p < 0.0001, respectively). Age (Odds ratio [OR] 1.09, 95% confidence interval [95% CI] 1.03-1.14), smoking (OR 6.18, 1.7-22.42), presence of comorbid disease (OR 31.73, 6.26-153.56), coronary artery disease (OR 9.26, 1.79-47.77), arrhythmia (OR 13.8, 1.56-122.22), hypertension (OR 14, 4.28-45.74), diabetes (OR 7.22, 2-25.99) and congestive heart failure (OR 10.22, 1.13-92.93) were statistically associated with increased mortality (p < 0.05). Also increased neutrophil (OR 1.26, 1.08-1.46), C-reactive protein (CRP) (OR 1.01, 1.003-0.02), lactate dehydrogenase (LDH), (OR 1.002, 1.001-1.004), D-dimer (OR 1.001, 1.002-1.003), and aspartate transaminase (AST) levels (OR 1.05, 1.02-1.08 were associated with increased mortality. CONCLUSION: The presence of advanced age, active smoking, comorbidity, especially hypertension, diabetes, arrhythmia, coronary artery disease, congestive heart failure and neutrophil, C-reactive protein, lactate dehydrogenase, D-dimer and aspartate transaminase were associated with mortality. The efficacy of Lpv/r, warrants further verification in future studies.

CT visual quantitative evaluation of hypertensive patients with coronavirus disease (COVID-19): Potential influence of angiotensin converting enzyme inhibitors / angiotensin receptor blockers on severity of lung involvement.

OBJECTIVE: There is not enough data on the effect of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) on lung involvement in patients with COVID-19 pneumonia and hypertension (HT). Our aim was to compare the lung involvement of the HT patients hospitalized for COVID-19 using ACEIs/ARBs with the patients taking other anti-HT medications. METHODS: : Patients who have a diagnosis of HT among the patients treated for laboratory-confirmed COVID-19 between 31 March 2020 and 28 May 2020 were included in the study. One hundred and twenty-four patients were divided into two as ACEIs/ARBs group (n = 75) and non-ACEIs/ARBs group (n = 49) according to the anti-HT drug used. The chest CT involvement areas of these two groups were evaluated quantitatively by two observers including all lobes, and total severity score (TSS) was calculated. These TSS values were compared between drug groups and clinical groups. RESULTS: In clinical classification; there were 4 (%3.2) asymptomatic, 5 (4.0%) mild type, 92 (74.1%) common type, 14 (11.3%) severe type, 9 (7.3%) critical type patients. ACEI/ARB group's TSS (mean±SD, 7.74 ± 3.54) was statistically higher than other anti-HT medication group (mean±SD, 4.40 ± 1.89) (p < .001). Likewise, severe-critical clinical type's TSS (mean±SD, 9.17 ± 3.44) was statistically higher than common type (mean±SD, 5.76 ± 3.07) (p < .001). Excellent agreement was established between the two blinded observers in the TSS measurements. CONCLUSIONS: Quantitative evaluation of CT and TSS score can give an idea about the clinical classification of the patient. TSS is higher in ACEI/ARB group than non-ACEIs/ARBs group.

Smoking and comorbidities are associated with COVID-19 severity and mortality in 565 patients treated in Turkey: a retrospective observational study

SUMMARY OBJECTIVE: We aimed to explore the prevalence of smoking rates and comorbidities and evaluate the relationship between them and disease severity and mortality in inpatients with COVID-19. METHODS: COVID-19 patients were divided into the following groups: clinic group, intensive care unit (ICU) group, survivors, and non-survivors. Non-COVID-19 patients were included as a control group. The groups were compared. RESULTS: There was no difference between patients with and without COVID-19 in terms of smoking, asthma, diabetes, dementia, coronary artery disease (CAD), hypertension, chronic renal failure and arrhythmia (p&gt;0.05). Older age (Odds ratio (OR), 1.061;95% confidence interval (CI): 1.041-1.082;p&lt;0.0001), chronic obstructive pulmonary disease (COPD) (OR, 2.775;95% CI: 1.128-6.829;p=0.026) and CAD (OR, 2.696;95% CI: 1.216-5.974;p=0.015) were significantly associated with ICU admission. Current smoking (OR, 5.101;95% CI: 2.382-10.927;p&lt;0.0001) and former smoking (OR, 3.789;95% CI: 1.845-7.780;p&lt;0.0001) were risk factors for ICU admission. Older age (OR;1.082;95% CI: 1.056-1.109;p&lt;0.0001), COPD (OR, 3.213;95% CI: 1.224-8.431;p=0.018), CAD (OR, 6.252;95% CI: 2.171-18.004;p=0.001) and congestive heart failure (CHF) (OR, 5.917;95% CI 1.069-32.258;p=0.042), were significantly associated with mortality. Current smoking (OR, 13.014;95% CI: 5.058-33.480;p&lt;0.0001) and former smoking (OR, 6.507;95% CI 2.731-15.501;p&lt;0.0001) were also risk factors for mortality. CONCLUSION: Smoking, older age, COPD, and CAD were risk factors for ICU admission and mortality in patients with COVID-19. CHF was not a risk factor for ICU admission;however, it was a risk factor for mortality. RESUMO OBJETIVO: Buscamos explorar as taxas de prevalência de tabagismo e de comorbidades e avaliar a relação entre elas e a severidade e mortalidade da doença em pacientes hospitalizados com COVID-19. MÉTODOS: Pacientes com COVID-19 foram divididos nos seguintes grupos: grupo clínico, grupo da unidade de terapia intensiva (UTI), grupo de sobreviventes e não-sobreviventes. Pacientes sem COVID-19 foram incluídos em um grupo de controle. Os grupos foram comparados. RESULTADOS: Não houve diferença entre os pacientes com e sem COVID-19 em termos de tabagismo, asma, diabetes, demência, doença arterial coronariana (DAC), hipertensão arterial, insuficiência renal crônica e arritmia (p&gt;0,05). Idade mais avançada (odds ratio (OR), 1,061;95% de intervalo de confiança (IC): 1,041-1,082;p&lt;0,0001), doença pulmonar obstrutiva crônica (DPOC) (OR, 2,775;95% IC: 1,128-6,829;p=0,026) e DAC (OR, 2,696;95% IC: 1,216-5,974;p=0,015) estavam significativamente associados com a admissão na UTI. O tabagismo atual (OR, 5,101;95% IC: 2,382-10,927;p &lt;0,0001) e tabagismo prévio (OR, 3,789;95% IC: 1,845-7,780;p&lt;0,0001) foram fatores de risco para admissão na UTI. Idade mais avançada (OR;1,082;95% IC: 1,056-1,109;&lt;0,0001), DPOC (OR, 3,213;95% IC: 1,224-8,431;p=0,018), DAC (OR, 6,252;95% IC: 2,171-18,004;p=0,001) e insuficiência cardíaca congestiva (ICC) (OR, 5,917;95% IC 1,069-32,258;p=0,042) estavam significativamente associados com mortalidade. O tabagismo atual (OR, 13,014;95% IC: 5,058-33,480;p&lt;0,0001) e o tabagismo prévio (OR, 6,507;95% IC 2,731-15,501;p&lt;0,0001) também foram fatores de risco para mortalidade. CONCLUSÃO: O tabagismo, a idade avançada, DPOC e DAC foram fatores de risco para admissão na UTI e mortalidade em pacientes com COVID-19. ICC não foi um fator de risco para admissão na UTI;no entanto, foi um fator de risco para mortalidade.

Smoking and comorbidities are associated with COVID-19 severity and mortality in 565 patients treated in Turkey: a retrospective observational study.

OBJECTIVE: We aimed to explore the prevalence of smoking rates and comorbidities and evaluate the relationship between them and disease severity and mortality in inpatients with COVID-19. METHODS: COVID-19 patients were divided into the following groups: clinic group, intensive care unit (ICU) group, survivors, and non-survivors. Non-COVID-19 patients were included as a control group. The groups were compared. RESULTS: There was no difference between patients with and without COVID-19 in terms of smoking, asthma, diabetes, dementia, coronary artery disease (CAD), hypertension, chronic renal failure and arrhythmia (p>0.05). Older age (Odds ratio (OR), 1.061; 95% confidence interval (CI): 1.041-1.082; p< 0.0001), chronic obstructive pulmonary disease (COPD) (OR, 2.775; 95% CI: 1.128-6.829; p=0.026) and CAD (OR, 2.696; 95% CI: 1.216-5.974; p=0.015) were significantly associated with ICU admission. Current smoking (OR, 5.101; 95% CI: 2.382-10.927; p<0.0001) and former smoking (OR, 3.789; 95% CI: 1.845-7.780; p<0.0001) were risk factors for ICU admission. Older age (OR; 1.082; 95% CI: 1.056-1.109; p<0.0001), COPD (OR, 3.213; 95% CI: 1.224-8.431; p=0.018), CAD (OR, 6.252; 95% CI: 2.171-18.004; p=0.001) and congestive heart failure (CHF) (OR, 5.917; 95% CI 1.069-32.258; p=0.042), were significantly associated with mortality. Current smoking (OR, 13.014; 95% CI: 5.058-33.480; p<0.0001) and former smoking (OR, 6.507; 95% CI 2.731-15.501; p<0.0001) were also risk factors for mortality. CONCLUSION: Smoking, older age, COPD, and CAD were risk factors for ICU admission and mortality in patients with COVID-19. CHF was not a risk factor for ICU admission; however, it was a risk factor for mortality.

Therapeutic dosing of low-molecular-weight heparin may decrease mortality in patients with severe COVID-19 infection.

BACKGROUND: Venous thromboembolism or extensive thrombosis is relatively common in patients with severe COVID-19 infection and has been associated with increased mortality. During the current COVID-19 pandemic, several prophylactic doses and types of low-molecular-weight heparin (LMWH) are being used worldwide; however, there are no high-quality studies or recommendations for an optimal prophylactic LMWH dose. OBJECTIVES: Investigate the relationship between coagulation parameters and the LMWH dose, and mortality and ICU admission in hospitalized patients with severe COVID-19 pneumonia. DESIGN: Retrospective. SETTING: Tertiary care hospital. PATIENTS AND METHODS: Data on clinical features, coagulation parameters and anticoagulant medications of inpatients with severe COVID-19 were collected for the period between 11 March 2020 and 31 April 2020. MAIN OUTCOME MEASURES: Mortality and ICU admission for prophylactic dose LMWH (0.5 mg/kg twice daily) and therapeutic dose LMWH (1 mg/kg twice daily). SAMPLE SIZE: 154 cases. RESULTS: Ninety-eight (63.6%) patients were treated with the LMWH prophylactic dose and 56 (36.4%) patients were treated with the therapeutic dose. Forty-four (44.9%) of 98 patients using the prophylactic dose LMWH died, while 10 (17.9%) of 56 patients using the therapeutic dose LMWH died (P=.001). Mortality was 6.4-fold higher in the prophylactic dose LMWH users than in the therapeutic dose LMWH users (OR=6.5, 95% CI: 2.4-17.6, P<.001). CONCLUSIONS: Therapeutic dosing of LMWH may decrease mortality in patients with severe COVID-19 infected pneumonia. More aggressive thromboprophylaxis regimens using higher doses of heparin should be evaluated in prospective studies. LIMITATIONS: Lack of information about bleeding complications. LMWH was not compared with other anticoagulant therapies. There was no comparison between our two groups on the APACHE score. Used different doses of LMWH in different clinics in our hospital. Single-center, retrospective study. CONFLICT OF INTEREST: None.