Biomarkers as predictors of mortality in critically ill obese patients with COVID-19 at high altitude.

BACKGROUND: Obesity is a common chronic comorbidity of patients with COVID-19, that has been associated with disease severity and mortality. COVID-19 at high altitude seems to be associated with increased rate of ICU discharge and hospital survival than at sea-level, despite higher immune levels and inflammation. The primary aim of this study was to investigate the survival rate of critically ill obese patients with COVID-19 at altitude in comparison with overweight and normal patients. Secondary aims were to assess the predictive factors for mortality, characteristics of mechanical ventilation setting, extubation rates, and analytical parameters. METHODS: This is a retrospective cohort study in critically ill patients with COVID-19 admitted to a hospital in Quito-Ecuador (2,850 m) from Apr 1, 2020, to Nov 1, 2021. Patients were cathegorized as normal weight, overweight, and obese, according to body mass index [BMI]). RESULTS: In the final analysis 340 patients were included, of whom 154 (45%) were obese, of these 35 (22.7%) were hypertensive and 25 (16.2%) were diabetic. Mortality in obese patients (31%) was lower than in the normal weight (48%) and overweight (40%) groups, but not statistically significant (p = 0.076). At multivariable analysis, in the overall population, older age (> 50 years) was independent risk factor for mortality (B = 0.93, Wald = 14.94, OR = 2.54 95%CI = 1.58-4.07, p < 0.001). Ferritin and the neutrophil/lymphocyte ratio were independent predictors of mortality in obese patients. Overweight and obese patients required more positive and-expiratory pressure compared to normal-weight patients. In obese patients, plateau pressure and mechanical power were significantly higher, whereas extubation failure was lower as compared to overweight and normal weight. CONCLUSIONS: This preliminary study suggests that BMI was not associated with mortality in critically ill patients at high altitude. Age was associated with an increase in mortality independent of the BMI. Biomarkers such as ferritin and neutrophils/lymphocytes ratio were independent predictors of mortality in obese patients with COVID-19 at high altitude.

Biological Markers to Predict Outcome in Mechanically Ventilated Patients with Severe COVID-19 Living at High Altitude.

BACKGROUND: There is not much evidence on the prognostic utility of different biological markers in patients with severe COVID-19 living at high altitude. The objective of this study was to determine the predictive value of inflammatory and hematological markers for the risk of mortality at 28 days in patients with severe COVID-19 under invasive mechanical ventilation, living at high altitude and in a low-resource setting. METHODS: We performed a retrospective observational study including patients with severe COVID-19, under mechanical ventilation and admitted to the intensive care unit (ICU) located at 2850 m above sea level, between 1 April 2020 and 1 August 2021. Inflammatory (interleukin-6 (IL-6), ferritin, D-dimer, lactate dehydrogenase (LDH)) and hematologic (mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), MPV/platelet ratio) markers were evaluated at 24 h and in subsequent controls, and when available at 48 h and 72 h after admission to the ICU. The primary outcome was the association of inflammatory and hematological markers with the risk of mortality at 28 days. RESULTS: We analyzed 223 patients (median age (1st quartile [Q1]-3rd quartile [Q3]) 51 (26-75) years and 70.4% male). Patients with severe COVID-19 and with IL-6 values at 24 h ≥ 11, NLR values at 24 h ≥ 22, and NLR values at 72 h ≥ 14 were 8.3, 3.8, and 3.8 times more likely to die at 28 days, respectively. The SOFA and APACHE-II scores were not able to independently predict mortality. CONCLUSIONS: In mechanically ventilated patients with severe COVID-19 and living at high altitude, low-cost and immediately available blood markers such as IL-6 and NLR may predict the severity of the disease in low-resource settings.

Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study.

Purpose: The effect of high altitude ( ≥ 1500 m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level. Methods: A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Results: Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value <.001) and diabetes mellitus (20.5% vs. 37.2% with p-value <.001), less probability of having a capillary refill time > 3 sec (13.7% vs. 30.1%, p-value <.001), and less severity-of-illness condition (APACHE II score, 17.5 ± 8.1 vs. 20 ± 8.2, p < .01). After adjusting for key confounders high altitude is associated with significant higher probabilities of ICU survival/discharge (HR: 1.74 [95% CI: 1.46-2.08]) and hospital survival/discharge (HR: 1.35 [95% CI: 1.18-1.55]) than patients treated at sea level. Conclusions: Patients treated at high altitude at any time point during the study period were 74% more likely to experience ICU survival/discharge and 35% more likely to experience hospital survival/discharge than to the sea-level group. Possible reasons for these findings are genetic and physiological adaptations due to exposure to chronic hypoxia.

Neutrophil-to-lymphocyte ratio and mean platelet volume in the diagnosis of bacterial infections in COVID-19 patients. A preliminary analysis from Ecuador.

INTRODUCTION: Hospitalized COVID-19 patients are at risk of hospital infection. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-C-reactive protein ratio (LCR) and mean platelet volume (MPV) are established inflammation markers reflecting the systemic inflammatory response. The objective of this study was to evaluate the clinical characteristics of patients with COVID-19 and bacterial co-infections, as well as the correlation with NLR and MPV. METHODS: We assessed the role of the NLR and MPV in diagnosing bacterial infections in COVID-19 patients. The Wilcoxon test was used to compare the mean NLR and MPV between the diagnostic evaluation moments, while the Mann-Whitney test was used to compare NLR and MPV by sex and age. RESULTS: The NLR was compared three days before the culture and the day of taking the culture, observing significant differences (p=0.020). MPV three days before the culture and the day of the culture were compared, also observing significant differences (p=0.031). NLR and MPV were compared at the different evaluation times according to sex and age group, observing for the age group significant differences for the NLR three days before the culture (p=0.004). CONCLUSION: In our study, there were significant differences in NLR and MPV between the three days before culture and the day of culture. It is advisable to continue to enrol more patients in the study so that in the future, we can add results on the diagnostic accuracy of the NLR and MPV in the timely diagnosis of bacterial infection in patients with COVID-19.

Native valve infective endocarditis caused by Staphylococcus hominis in a patient hospitalized with Covid-19. Report of a case

RESUMEN La enfermedad del COVID-19 presenta actualmente una gama de síntomas que van desde la presencia de síntomas clásicos de compromiso de las vías respiratorias altas y bajas hasta alteraciones sensitivas como anosmia o trastornos del gusto. Las trombosis valvulares cardíacas y la endocarditis subsecuente son presentaciones extremadamente raras y poco descritas de la infección por COVID-19. Presentamos el caso de un paciente positivo para virus SARS-Cov2, quien desarrolló una bacteriemia por Staphylococcus hominis y que, ante episodios febriles persistentes y posterior evaluación de diagnósticos diferenciales, se identificó el diagnóstico de endocarditis infecciosa en válvula aórtica nativa sana -mediante ecocardiografía-, la cual fue adquirida en el hospital. ABSTRACT Covid-19 disease shows many different manifestations, from common symptoms affecting both the upper and lower respiratory tract, and also sensorial alterations such as anosmia or taste perversion. Heart valve thrombosis and subsequent endocarditis are extremely rare manifestations and they have been scarcely described within the context of Covid-19. We present a case of a patient that was positive for SARS-Cov-2, who developed Staphylococcus hominis bacteremia. Afterwards, he developed persistent fever, and after ruling out some differential diagnoses, a diagnosis of infective endocarditis affecting a native healthy aortic valve was made, using cardiac ultrasonography. This occurrence was considered to be hospital-acquired.

Native valve infective endocarditis caused by Staphylococcus hominis in a patient hospitalized with Covid-19. Report of a case

RESUMEN La enfermedad del COVID-19 presenta actualmente una gama de síntomas que van desde la presencia de síntomas clásicos de compromiso de las vías respiratorias altas y bajas hasta alteraciones sensitivas como anosmia o trastornos del gusto. Las trombosis valvulares cardíacas y la endocarditis subsecuente son presentaciones extremadamente raras y poco descritas de la infección por COVID-19. Presentamos el caso de un paciente positivo para virus SARS-Cov2, quien desarrolló una bacteriemia por Staphylococcus hominis y que, ante episodios febriles persistentes y posterior evaluación de diagnósticos diferenciales, se identificó el diagnóstico de endocarditis infecciosa en válvula aórtica nativa sana -mediante ecocardiografía-, la cual fue adquirida en el hospital. ABSTRACT Covid-19 disease shows many different manifestations, from common symptoms affecting both the upper and lower respiratory tract, and also sensorial alterations such as anosmia or taste perversion. Heart valve thrombosis and subsequent endocarditis are extremely rare manifestations and they have been scarcely described within the context of Covid-19. We present a case of a patient that was positive for SARS-Cov-2, who developed Staphylococcus hominis bacteremia. Afterwards, he developed persistent fever, and after ruling out some differential diagnoses, a diagnosis of infective endocarditis affecting a native healthy aortic valve was made, using cardiac ultrasonography. This occurrence was considered to be hospital-acquired.