Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 6 de 6
Filter
1.
BMC Infect Dis ; 22(1): 378, 2022 Apr 15.
Article in English | MEDLINE | ID: covidwho-1793976

ABSTRACT

BACKGROUND: Serum procalcitonin (PCT) has become an emerging prognostic biomarker of disease progression in patients with COVID-19. This study aims to determine the optimal cut-off value of PCT with regards to important clinical outcomes, especially for mechanical ventilation and all-cause mortality among moderate to severe COVID-19 patients in Malaysia. METHODS: A total of 319 moderate to severe COVID-19 patients hospitalized at the National Referral Hospital in December 2020 were included in the study retrospectively. Demographics, comorbidities, the severity of COVID-19 infection, laboratory and imaging findings, and treatment given were collected from the hospital information system for analysis. The optimal cut-point values for PCT were estimated in two levels. The first level involved 276 patients who had their PCT measured within 5 days following their admission. The second level involved 237 patients who had their PCT measured within 3 days following their admission. Further, a propensity score matching analysis was performed to determine the adjusted relative risk of patients with regards to various clinical outcomes according to the selected cut-point among 237 patients who had their PCT measured within 3 days. RESULTS: The results showed that a PCT level of 0.2 ng/mL was the optimal cut-point for prognosis especially for mortality outcome and the need for mechanical ventilation. Before matching, patients with PCT ≥ 0.2 ng/mL were associated with significantly higher odds in all investigated outcomes. After matching, patients with PCT > 0.2 ng/mL were associated with higher odds in all-cause mortality (OR: 4.629, 95% CI 1.387-15.449, p = 0.0127) and non-invasive ventilation (OR: 2.667, 95% CI 1.039-6.847, p = 0.0415). Furthermore, patients with higher PCT were associated with significantly longer days of mechanical ventilation (p = 0.0213). There was however no association between higher PCT level and the need for mechanical ventilation (OR: 2.010, 95% CI 0.828-4.878, p = 0.1229). CONCLUSION: Our study indicates that a rise in PCT above 0.2 ng/mL is associated with an elevated risk in all-cause mortality, the need for non-invasive ventilation, and a longer duration of mechanical ventilation. The study offers concrete evidence for PCT to be used as a prognostication marker among moderate to severe COVID-19 patients.

2.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-314924

ABSTRACT

The susceptible-infectious-removed (SIR) model offers the simplest framework to study transmission dynamics of COVID-19, however, it does not factor in its early depleting trend observed during a lockdown. We modified the SIR model to specifically simulate the early depleting transmission dynamics of COVID-19 to better predict its temporal trend in Malaysia. The classical SIR model was fitted to observed total (I total), active (I), and removed (R) cases of COVID-19 before lockdown to estimate the basic reproduction number. Next, the model was modified with a partial time-varying force of infection, given by a proportionally depleting transmission coefficient, β t , and a fractional term, z . The modified SIR model was then fitted to observed data over 6 weeks during the lockdown. Model fitting and projection were validated using the mean absolute percent error (MAPE). The transmission dynamics of COVID-19 was interrupted immediately by the lockdown. The modified SIR model projected the depleting temporal trends with lowest MAPE for I total, followed by I, I daily, and R. During lockdown, the dynamics of COVID-19 depleted at a rate of 4·7% each day with a decreased capacity of 40%. For 7–day and 14–day projections, the modified SIR model accurately predicted I total, I, and R. The depleting transmission dynamics for COVID-19 during lockdown can be accurately captured by time-varying SIR model. Projection generated based on observed data is useful for future planning and control of COVID-19.

3.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-314923

ABSTRACT

Introduction: The latest outbreak of COVID-19 in Malaysia emerged in early September and had two determinants. First, it involved incarcerated populations from four prisons located in Sabah, Kedah and Penang states. Second, the Sabah state by-election campaigns accelerated the spread of COVID-19 in the state and across the South China Sea into the west Malaysia. The emergence of multiple incarcerated clusters at different time points may shadow the real dynamics of transmission of COVID-19 in the community and lead to inaccurate interpretation and conclusion. The study aimed to reveal the real spreading pattern of COVID-19 by excluding incarcerated clusters in the modelling. Method: ology: We extended the susceptible-infectious-removed (SIR) model to include an additional class for non-isolated active cases, which was assumed to impel the transmission of COVID-19 in the community. The model was fitted to actual total and removed cases for estimation of duration of transmission and hospitalization. The parameters were then applied to model the transmission for COVID-19 in the community. Results: : The presence of incarcerated clusters shadowed the dynamics of transmission of COVID-19 with a lower reproduction number of 2.0. The proportion of non-isolated active cases increased slowly from 49.4% on 1 September 2020 to 60.3% on 8 October 2020. In the absence of incarcerated clusters, the dynamics of transmission of COVID-19 appeared differently with a higher reproduction number of 2.3. The proportion of non-isolated active cases increased tremendously from 22.1% on 1 September 2020 to 63.7% on 8 October 2020. The tremendous increase of non-isolated active cases impelled the dynamics of transmission of COVID-19 in the community following the Sabah state by-election campaigns and more inter-state travels. Conclusion: The inclusion of incarcerated clusters shadowed the dynamics of transmission of COVID-19 in the community with a lower transmission rate, which might lead to wrong interpretation of the dynamics of transmission in the community.

4.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-292350

ABSTRACT

Background: Serum procalcitonin (PCT) has become an emerging prognostic biomarker of disease progression in patients with COVID-19. This study aims to determine the optimal cut-off value of PCT with regards to important clinical outcomes, especially for mechanical ventilation and all-cause mortality among moderate to severe COVID-19 patients in Malaysia. Methods: A total of 319 moderate to severe COVID-19 patients hospitalized at the National Referral Hospital in December 2020 were included in the study retrospectively. Demographics, comorbidities, the severity of COVID-19 infection, laboratory and imaging findings, and treatment given were collected from the hospital information system for analysis. The optimal cut-point values for PCT were estimated in two levels. The first level involved 276 patients who had their PCT measured within 5 days following their admission. The second level involved 237 patients who had their PCT measured within 3 days following their admission. Further, a propensity score matching analysis was performed to determine the adjusted relative risk of patients with regards to various clinical outcomes according to the selected cut-point among 237 patients who had their PCT measured within 3 days. Results: The results showed that a PCT level of 0.2 ng/mL was the optimal cut-point for prognosis especially for mortality outcome and the need for mechanical ventilation. Before matching, patients with PCT ≥ 0.2ng/mL were associated with significantly higher odds in all investigated outcomes. After matching, patients with PCT > 0.2 ng/mL were associated with higher odds in all-cause mortality (OR: 4.629, 95% CI: 1.387 – 15.449, p = 0.0127) and non-invasive ventilation (OR: 2.667, 95% CI: 1.039 – 6.847, p = 0.0415). Furthermore, patients with higher PCT were associated with significantly longer days of mechanical ventilation (p = 0.0213). There was however no association between higher PCT level and the need for mechanical ventilation (OR: 2.010, 95% CI: 0.828 - 4.878, p = 0.1229). Conclusion: Our study indicates that a rise in PCT above 0.2ng/ml is associated with an elevated risk in all-cause mortality, the need for non-invasive ventilation, and a longer duration of mechanical ventilation. The study offers concrete evidence for PCT to be used as a prognostication marker among moderate to severe COVID-19 patients.

5.
Epidemics ; 37: 100517, 2021 12.
Article in English | MEDLINE | ID: covidwho-1482585

ABSTRACT

INTRODUCTION: As of 3rd June 2021, Malaysia is experiencing a resurgence of COVID-19 cases. In response, the federal government has implemented various non-pharmaceutical interventions (NPIs) under a series of Movement Control Orders and, more recently, a vaccination campaign to regain epidemic control. In this study, we assessed the potential for the vaccination campaign to control the epidemic in Malaysia and four high-burden regions of interest, under various public health response scenarios. METHODS: A modified susceptible-exposed-infectious-recovered compartmental model was developed that included two sequential incubation and infectious periods, with stratification by clinical state. The model was further stratified by age and incorporated population mobility to capture NPIs and micro-distancing (behaviour changes not captured through population mobility). Emerging variants of concern (VoC) were included as an additional strain competing with the existing wild-type strain. Several scenarios that included different vaccination strategies (i.e. vaccines that reduce disease severity and/or prevent infection, vaccination coverage) and mobility restrictions were implemented. RESULTS: The national model and the regional models all fit well to notification data but underestimated ICU occupancy and deaths in recent weeks, which may be attributable to increased severity of VoC or saturation of case detection. However, the true case detection proportion showed wide credible intervals, highlighting incomplete understanding of the true epidemic size. The scenario projections suggested that under current vaccination rates complete relaxation of all NPIs would trigger a major epidemic. The results emphasise the importance of micro-distancing, maintaining mobility restrictions during vaccination roll-out and accelerating the pace of vaccination for future control. Malaysia is particularly susceptible to a major COVID-19 resurgence resulting from its limited population immunity due to the country's historical success in maintaining control throughout much of 2020.


Subject(s)
COVID-19 , Humans , Malaysia/epidemiology , SARS-CoV-2 , Vaccination
6.
Sci Rep ; 10(1): 21721, 2020 12 10.
Article in English | MEDLINE | ID: covidwho-970770

ABSTRACT

The susceptible-infectious-removed (SIR) model offers the simplest framework to study transmission dynamics of COVID-19, however, it does not factor in its early depleting trend observed during a lockdown. We modified the SIR model to specifically simulate the early depleting transmission dynamics of COVID-19 to better predict its temporal trend in Malaysia. The classical SIR model was fitted to observed total (I total), active (I) and removed (R) cases of COVID-19 before lockdown to estimate the basic reproduction number. Next, the model was modified with a partial time-varying force of infection, given by a proportionally depleting transmission coefficient, [Formula: see text] and a fractional term, z. The modified SIR model was then fitted to observed data over 6 weeks during the lockdown. Model fitting and projection were validated using the mean absolute percent error (MAPE). The transmission dynamics of COVID-19 was interrupted immediately by the lockdown. The modified SIR model projected the depleting temporal trends with lowest MAPE for I total, followed by I, I daily and R. During lockdown, the dynamics of COVID-19 depleted at a rate of 4.7% each day with a decreased capacity of 40%. For 7-day and 14-day projections, the modified SIR model accurately predicted I total, I and R. The depleting transmission dynamics for COVID-19 during lockdown can be accurately captured by time-varying SIR model. Projection generated based on observed data is useful for future planning and control of COVID-19.


Subject(s)
COVID-19 , Models, Biological , Pandemics , SARS-CoV-2 , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/therapy , Humans , Malaysia/epidemiology
SELECTION OF CITATIONS
SEARCH DETAIL