Predictive Role of Biomarkers in COVID-19 Mortality.

Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in high mortality among patients in critical intensive care units. Hence, identifying mortality markers in the follow-up and treatment of these patients is essential. This study aimed to evaluate the relationships between mortality rates in patients with COVID-19 and the neutrophil/lymphocyte ratio (NLR), derived NLR (dNLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic inflammation response index (SII), and systemic inflammatory response index (SIRI). Methodology In this study, we assessed 466 critically ill patients diagnosed with COVID-19 in the adult intensive care unit of Kastamonu Training and Research Hospital. Age, gender, and comorbidities were recorded at the time of admission along with NLR, dNLR, MLR, PLR, SII, and SIRI values from hemogram data. Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and mortality rates over 28 days were recorded. Patients were divided into survival (n = 128) and non-survival (n = 338) groups according to 28-day mortality. Results A statistically significant difference was found between leukocyte, neutrophil, dNLR, APACHE II, and SIRI parameters between the surviving and non-surviving groups. A logistic regression analysis of independent variables of 28-day mortality identified significant associations between dNLR (p = 0.002) and APACHE II score (p < 0.001) and 28-day mortality. Conclusions Inflammatory biomarkers and APACHE II score appear to be good predictive values for mortality in COVID-19 infection. The dNLR value was more effective than other biomarkers in estimating mortality due to COVID-19. In our study, the cut-off value for dNLR was 3.64.

Does prolonged prone position affect intracranial pressure? prospective observational study employing Optic nerve sheath diameter measurements.

BACKGROUND: Our aim in this observational prospective study is to determine whether the prone position has an effect on intracranial pressure, by performing ultrasound-guided ONSD (Optic Nerve Sheath Diameter) measurements in patients with acute respiratory distress syndrome (ARDS) ventilated in the prone position. METHODS: Patients hospitalized in the intensive care unit with a diagnosis of ARDS who were placed in the prone position for 24 h during their treatment were included in the study. Standardized sedation and neuromuscular blockade were applied to all patients in the prone position. Mechanical ventilation settings were standardized. Demographic data and patients' pCO2, pO2, PaO2/FiO2, SpO2, right and left ONSD data, and complications were recorded at certain times over 24 h. RESULTS: The evaluation of 24-hour prone-position data of patients with ARDS showed no significant increase in ONSD. There was no significant difference in pCO2 values either. PaO2/FiO2 and pO2 values demonstrated significant cumulative increases at all times. Post-prone SPO2 values at the 8th hour and later were significantly higher when compared to baseline (p < 0.001). CONCLUSION: As a result of this study, it appears that the prone position does not increase intracranial pressure during the first 24 h and can be safely utilized, given the administration of appropriate sedation, neuromuscular blockade, and mechanical ventilation strategy. ONSD measurements may increase the safety of monitoring in patients ventilated in the prone position.

Ferritin / albumin ratio could be a new indicator of COVID-19 disease mortality.

INTRODUCTION: Despite significant advances in the management of patients with COVID-19, there is a need for markers to guide treatment and predict disease severity. In this study, we aimed to evaluate the relationship of the ferritin/albumin (FAR) ratio with disease mortality. METHODOLOGY: Acute Physiology and Chronic Health Assessment II scores and laboratory results of patients diagnosed with severe COVID-19 pneumonia were retrospectively analyzed. The patients were divided into two groups: survivors and non-survivors. Data for ferritin, albumin, and ferritin/albumin ratio among COVID-19 patients were analyzed and compared. RESULTS: The mean age was higher in non-survivors (p = 0.778, p < 0.001, respectively). The ferritin/albumin ratio was significantly higher in the non-survival group (p < 0.05). Taking the cut-off value of the ferritin/albumin ratio of 128.71 in the ROC analysis, it predicted the critical clinical status of COVID-19 with 88.4% sensitivity and 88.4% specificity. CONCLUSIONS: ferritin/albumin ratio is a practical, inexpensive, and easily accessible test that can be used routinely. In our study, the ferritin/albumin ratio has been identified as a potential parameter in determining the mortality of critically ill COVID-19 patients treated in intensive care.

Neurological Symptoms and Signs Observed in Critical COVID-19 Patients may be Precursors of Existing Cerebrovascular Disease

Objective: Health professionals have had difficulties in diagnosing many previously known diseases due to COVID-19 disease, neurological diseases being one of them. We aimed to evaluate neurological manifestations in critical COVID-19 patients. Materials and Methods: Five hundred ninety five critical COVID-19 patients admitted to the COVID intensive care unit between January and June 2020 were evaluated retrospectively. The patients were divided into two groups as patients with neurological symptoms and diagnosed with cerebrovascular disease (group 1) and patients with neurological symptoms but not diagnosed with cerebrovascular disease disease (group 2). Neurological symptoms and findings, radiological evaluations, demographic data, laboratory values, hospitalization days, mechanical ventilator needs and mortality of patients were retrospectively analyzed. Results: Neurological signs and symptoms were observed in 148 (24.8%) of a total of 595 critic COVID-19 patients. Of 148 patients with neurological symptoms/signs, 44 were diagnosed with a cerebrovascular disease (group 1) and 104 could not be diagnosed with any cerebrovascular disease (group 2). The distribution rates of the symptoms and signs of the patients included in the study were change of consciousness 6.5%, headache 5.6%, dizziness 6.5%, plegia 4.3%, paresis 5.8%, anisocoria 2.1%, taste-smell 5.8%, epileptic seizure 3.6% and numbness 13.4%. observed (Table 1). In general, neurological symptoms and signs were observed at a higher rate in group 1 patients (Figure 1). Conclusion: The presence of cerebrovascular disease should be more strongly suspected in COVID-19 patients with paresis, change of consciousness, numbness, taste/smell disturbance, and plegia. The rate of ischemic cerebrovascular disease in COVID-19 patients is approximately 7 times higher than the rate of hemorrhagic cerebrovascular disease. [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI 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.)

Spontan Pnömomediastinum ve COVID-19

Amaç: Hem pnömotoraks (PNX) hem de pnömomediastinum (PNM) mekanik ventilasyonun bilinen komplikasyonlarıdır. Bununla birlikte, barotravma olmasa bile, PNX veya PNM veya daha nadiren her ikisi de koronavirüs hastalığı-2019’a (COVID-19) bağlı olarak gelişebilir. PNM, mediasten içinde bulunan serbest hava veya gaz olarak tanımlanır. Spontan PNM (SPNM), göğüs travması gibi gözle görülür herhangi bir neden ile ilişkili olmayan mediasten içinde bulunan serbest hava veya gaz olarak tanımlanır. Olgu: 01.01.2021-31.12.2021 tarihileri arasında Kastamonu Eğitim ve Araştırma Hastanesi COVID-19 Yoğun Bakım Üniteleri’nde takip edilen 7 hastada SPNX/SPNM saptanmıştır. Toplanan veriler arasında yaş, cinsiyet, IMV veya N-IMV tedavisi altında iken, yoğun bakımda yatışın kaçıncı gününde ve SPNX/SPNM hangisinin geliştiği, tüp torakostomi ihtiyacı ve şifa-eks durumu mevcuttur. Yedi hastamızın üçü kadın, dördü erkektir. Íki hastamızda SPNX ve SPNM birlikte görünmüş ve bu hastalara tüp torakostomi uygulanmıştır. SPNX/SPNM, iki hastamızda N-IMV altında gelişmişken, beş hastamızda IMV altında gelişmiştir. SPNX/SPNM, hastalarımızın yoğun bakıma alındıktan sonra ortalama 5. gününde gelişmiştir. Beş hastamız eksitus olmuş, iki hastamız ise servise devredilmiştir. Sonuç: COVID-19, ARDS’nin önemli bir yeni nedenidir. Beş ARDS hastalarında barotravma insidansının daha yüksek olduğu, çeşitli çalışmalarda COVID öncesi dönem kadar erken bir tarihte bildirilmiştir. Gerçekten de, COVID-19 pandemisi nedeniyle ARDS olgularının artmasıyla birlikte, PNX ve PNM olgularının insidansında da bir artış olmuştur. PNM’nin kesin mekanizması bilinmemekle birlikte, SPNM genellikle kendi kendini sınırlayan bir hastalıktır. Bununla birlikte, potansiyel olarak ciddi dolaşım ve solunum patolojisine neden olabilir. Bu nedenle, COVID-19 hastalarında SPNM oluşumu, kötüleşen hastalığın potansiyel bir göstergesi olarak yakından izlenmelidir. COVID-19 hastalarında PNX/ PMN’nin insidansı, patogenezi ve öngörücüleri şu anda belirsiz ve hatta çelişkilidir. Sonuç olarak tüm bu nedenler, PNX’in ve PNM’nin COVID19’un ciddi bir komplikasyonu olduğunu düşündürmektedir. Bu durumun kötü prognozun belirteci olup olmadığını anlamak için daha kapsamlı çalışmalar gerekmektedir. (Turkish) [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI 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.)

Change of Critical COVID-19 Disease in Time/a Randomized Controlled Study

Objective: COVID-19 disease is unfortunately not yet understood and a definitive treatment has not been found. The aim of this study is to investigate the changes in clinical and laboratory tests of critical COVID- 19 patients followed in the intensive care unit between March/2020 and December/2020 and to evaluate the factors that cause these changes with literature information. Materials and Methods: In the study, during the beginning of the pandemic and its progress;50 COVID-19 patients treated in the intensive care unit (ICU) between March-April-May/2020 were defined as group 1, and 50 COVID-19 patients treated in the ICU between October-November- December/2020 were defined as group 2. Clinical, laboratory and intensive care processes of the patients in the groups were analyzed retrospectively and compared. Results: Age and gender distribution in terms of demographic data was similar between group 1 and group 2. APACHE-II score average of group 1 was 22, and APACHE-II score average of group 2 was 25. There was no statistically significant difference between the demographic data of the groups (Table 1). As a result of statistical analysis, while there was no significant difference between the groups in terms of CRP and ferritin values, there was a significant difference between the D-dimer values. The values of the patients in group 1 were found to be higher than in group 2 (Table 2). Group 2 patients had higher 28-day mortality, and this result was statistically significant (p=0.006). Transfer rates of group1 patients to the service after intensive care were found to be statistically higher (p=0.029) (Table 3). Conclusion: As a result of this study, 28-day mortality was found to be different between similar patient groups who were admitted to intensive care during different periods of the pandemic.The reasons for this may be: changes in pathogenicity as a result of viral mutations, different immune responses of hosts to viral infection. Another factor influencing this outcome may be the presence of less experienced healthcare professionals in critically ill care. [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI 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.)