ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Covid-19 caused by the novel SARS-CoV-2 has emerged as a global health crisis with various clinical complications. Covid-19 related respiratory manifestations have been reported as mild, moderate to severe including acute lung injury and acute respiratory distress syndrome necessitating non-invasive forms of oxygenation to mechanical ventilation (MV). MV patients frequently undergo prolonged hospitalizations with substantial morbidity and mortality. We sought to evaluate risk factors for MV in our cohort. METHODS: We conducted a retrospective cohort study of patients admitted in our institution from March 1st to June 21st2020, to assess risk factors for Covid-19 related respiratory failure requiring MV. The original cohort encompassed 166 MV and 503 non MV patients. Information from our hospital medical records was extracted, which included demographics, presenting symptoms, past medical history, vital signals, and laboratory data and need for MV. We propensity matched 166 MV with a concurrent cohort of non MV patients in our institution. Covariates applied in matching included age, gender, race, and body mass index (BMI). The admission clinical attributes and laboratory parameters were analyzed, along with outcomes. RESULTS: The mean age of our matched cohort was 63.8 years. Mechanically Ventilated patients had a higher incidence of tachycardia (heart rate > 125) (p <.001), elevated respiratory rate > 24 cycles per minute (p <.001), fever > 97.8 F (Temperature > (p =.037), shortness of breath (p =.001), and headaches (p =.005). In addition, mechanically ventilated patients had a lower serum albumin (g/dl) ≤ 3 units (p <. 001), elevated serum creatinine (mg/dl) ≥ 1.135 units (p =.02), elevated serum CRP-HS ≥ 123 units (p =.005), HbA1C (%) > 6.6 units (p =.004), serum lactic acid (mmol/L) > 1.7 units (p =.003), serum LDH U/L > 465 U/L (p <.001), Procalcitonin (ng/ml) >.305 units (p <0.001), SGOT IU/L or AST IU/L ≥ 54 units (p < 0.001), SGPT or ALT IU/L ≥ 41 units (p =.021), and WBC count > 8.4 k/ul (p <.001). Furthermore, tachycardia (OR = 3.98, p =.001), HbA1C (OR = 2.36, p =.008), serum LDH (OR = 1.9, p =.041), and absolute lymphocyte percent ≤ 12 (OR = 1.98, p =.022) predicted mechanical ventilation in all matched patients in our institutional cohort. CONCLUSIONS: Our case series provides clinical characteristics, laboratory parameters, and predictors for mechanical ventilation in matched patients with Covid-19. Elevated heart rate, HbA1C, serum LDH and decreased lymphocyte percentage were predictors for mechanical ventilation. Tachycardia had the highest odds of 3.98. CLINICAL IMPLICATIONS: Several clinical and laboratory parameters can be utilized for evaluating and stratifying Covid-19 patients’ risk for mechanical ventilation. These risk factors will need further validation in other similar cohorts. DISCLOSURES: No relevant relationships by Olawale Akande, source=Web Response No relevant relationships by Olga Badem, source=Web Response No relevant relationships by Premila Bhat, source=Web Response No relevant relationships by Utpal Bhatt, source=Web Response No relevant relationships by Diego Castellon, source=Web Response No relevant relationships by Bhargav Desai, source=Web Response No relevant relationships by Basilides Fermin, source=Web Response No relevant relationships by Shurovi Jafar, source=Web Response No relevant relationships by KELASH KUMAR, source=Web Response No relevant relationships by Juan Martinez Zegarra, source=Web Response No relevant relationships by Tanveer Mir, source=Web Response No relevant relationships by Parvez Mir, source=Web Response No relevant relationships by Luis Morón Mercado, source=Web Response No relevant relationships by Beatriz Omeragic, source=Web Response No relevant relationships by Maxine Orris, source=Web Response No relevant relationships by Priyank Patel, source=Web Response No relevant relationships by Giovanna Ramirez-Barbieri, source=Web Response No relevant relationships by Luis Santana Alcantara, source=Web Response No relevant relationships by Karthik Seetharam, source=Web Response No relevant relationships by Jilan Shah, source=Web Response No relevant relationships by Phanthira Tamsukhin, source=Web Response No relevant relationships by Zeyar Thet, source=Web Response No relevant relationships by Elbia Toribio, source=Web Response No relevant relationships by Thinzar Wai, source=Web Response No relevant relationships by Vamsi Yenugadhati, source=Web Response
ABSTRACT
SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: In March, 2020 the World Health Organization (“WHO”) declared SARS-CoV-2 as a global pandemic. SARS-CoV-2 viral infection has been noted to present a variety of symptoms including anosmia (loss of sense of smell), dyspnea, cough, fever, diarrhea and acute respiratory failure. Spontaneous pneumomediastinum is a rare complication with viral pneumonia. We here present one of the two cases with this finding. CASE PRESENTATION: 63-years-old male presented with fever, chills, and progressive shortness of breath over the past week. Patient was previously diagnosed with corona virus disease with reverse transcriptase RNA PCR test. Past medical history was significant for diabetes, hypertension and hyperlipidemia. On presentation, patient was hypoxic (SaO2 84%). Physical examination revealed reduced breath sounds bilaterally and soft-tissue crepitus in bilateral clavicle area. Laboratory test results showed elevated C-reactive protein concentration, leukocytosis, and lymphopenia. Chest Computed Tomography (CT) showed diffuse lower neck/chest wall subcutaneous emphysema with associated diffuse pneumomediastinum and bilateral ground-glass airspace infiltrates (Figure 1,2,3). Patient was started on anti-infective therapy with vancomycin, piperacillin/tazobactam, and azithromycin, and placed on nasal cannula at 4 liter/minute. On day four of admission, patient developed multi-organ failure requiring mechanical ventilation and vasopressor support. Later on day twelve, patient expired due to cardiopulmonary arrest. DISCUSSION: Pneumomediastinum is defined as the presence of free air in the mediastinum with an incidence of 1 in every 25,000 cases in ages between 5-34 years, predominantly found in males. It may be spontaneous from a predisposing factor or due to secondary causes. SARS-CoV-2 is a new addition to secondary pulmonary causes, being reported recently in literature. The pathophysiology of spontaneous pneumomediastinum is explained due to pressure gradient difference between alveoli and lung interstitial tissue. SARS-CoV-2 infects type I and II pneumocytes, disrupting alveolar membrane integrity leading to alveolar rupture and leakage of air into interstitial tissue, as well as severe hypoxemia increasing respiratory effort. Associated clinical symptoms of pneumomediastinum are varying, including dyspnea, although a portion of patient are asymptomatic. Pneumomediastinum is typically identified through chest x-ray with management being primary conservative. CONCLUSIONS: Spontaneous pneumomediastinum in association with SARS-CoV-2 is a serious condition and merits early recognition. Despite early diagnosis and optimal management, the mortality was 100% in our two patients of Covid-19 associated mediastinum. Reference #1: Wang J, Su X, Zhang T, Zheng C. Spontaneous Pneumomediastinum: A Probable Unusual Complication of Coronavirus Disease 2019 (COVID-19) Pneumonia. Korean J Radiol. 2020;21(5):627-628. doi:10.3348/kjr.2020.0281 Reference #2: Dionísio P, Martins L, Moreira S, et al. Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years. J Bras Pneumol. 2017;43(2):101-105. doi:10.1590/S1806-37562016000000052 Reference #3: Kolani S, Nawfal H, Haloua M, et al. Spontaneous pneumomediastinum occurring in the SARS-COV-2 infection [published online ahead of print, 2020 May 11]. IDCases. 2020;21:e00806. doi:10.1016/j.idcr.2020.e00806 DISCLOSURES: No relevant relationships by Darakhshan Ahmad, source=Web Response No relevant relationships by Marium Ghani, source=Web Response No relevant relationships by Parvez Mir, source=Web Response No relevant relationships by Judy Pham, source=Web Response No relevant relationships by Yariana Rodriguez-Ortiz, source=Web Response No relevant relationships by Phanthira Tamsukhin, source=Web Response