ABSTRACT
Introduction: The CoLab-score was originally developed and validated to rule out COVID-19 in suspected patients presenting in the emergency department [1, 2]. The CoLab-score includes the patient's age and ten blood parameters, reflecting the host response to SARSCoV-2 infection. Here, we investigated the CoLab-score over time in mechanically ventilated COVID-19 patients at the ICU. We hypothesized that the CoLab-score will decrease over time, independent of survival, disease severity and pandemic periods. This would create the opportunity to monitor COVID-19 patients and potentially ruling out the need for isolation when the host response decreases and the infection is overcome. Method(s): We used serial data of the Maastricht Intensive Care Covid (MaastrICCht) cohort of mechanically ventilated COVID-19 patients to investigate the association between time and daily CoLab-score using linear-mixed models. Crude models were adjusted for sex, APACHE II score, SOFA score, and stratified for intensive care mortality. Result(s): 324 patients (73% men), aged 64 +/- 12 years with 5959 daily CoLab-scores, were included. CoLab-score decreased with 0.31 points per day (95% CI -0.33 to -0.28). Adjustment for sex, APACHE II and stratification for mortality did not change this result. Conclusion(s): The CoLab-score decreased over time in mechanically ventilated ICU COVID-19 patients, with a point reduction per three days. This suggests that the CoLab-score eventually decreases to a normal state, reflecting a host response that has overcome infection. Future investigation is warranted to assess whether the need for isolation can be ruled out based on the CoLab-score.
ABSTRACT
INTRODUCTION: In the first wave, thrombotic complications were common in COVID-19 patients. It is unknown whether state-of-the-art treatment has resulted in less thrombotic complications in the second wave. METHODS: We assessed the incidence of thrombotic complications and overall mortality in COVID-19 patients admitted to eight Dutch hospitals between September 1st and November 30th 2020. Follow-up ended at discharge, transfer to another hospital, when they died, or on November 30th 2020, whichever came first. Cumulative incidences were estimated, adjusted for competing risk of death. These were compared to those observed in 579 patients admitted in the first wave, between February 24th and April 26th 2020, by means of Cox regression techniques adjusted for age, sex and weight. RESULTS: In total 947 patients with COVID-19 were included in this analysis, of whom 358 patients were admitted to the ICU; 144 patients died (15%). The adjusted cumulative incidence of all thrombotic complications after 10, 20 and 30 days was 12% (95% confidence interval (CI) 9.8-15%), 16% (13-19%) and 21% (17-25%), respectively. Patient characteristics between the first and second wave were comparable. The adjusted hazard ratio (HR) for overall mortality in the second wave versus the first wave was 0.53 (95%CI 0.41-0.70). The adjusted HR for any thrombotic complication in the second versus the first wave was 0.89 (95%CI 0.65-1.2). CONCLUSIONS: Mortality was reduced by 47% in the second wave, but the thrombotic complication rate remained high, and comparable to the first wave. Careful attention to provision of adequate thromboprophylaxis is invariably warranted.