Blood Urea Nitrogen/Albumin Ratio and Mortality Risk in Patients with COVID-19.

Introduction: We researched blood urea nitrogen (BUN), albumin and their ratio (BAR), and compared them with C-reactive protein (CRP), D-dimer, and computed tomography severity scores (CT-SS), to predict in-hospital mortality. Methods: One-hundred and thirty-one coronavirus disease-2019 (COVID-19) confirmed patients brought to the emergency department (ED) were dispensed to the survivor or non-survivor group, in light of in-hospital mortality. Information on age, gender, complaints, comorbidities, laboratory parameters, and outcome were gathered from the patient's record files. Results: The median BUN, mean total protein, mean albumin, median BAR, median creatinine, median CRP, and median D-dimer were recorded. CT-SS were utilized in categorizing the patient as mild, moderate, and severe. In-hospital mortality occurred in 42 (32.06%) patients (non-survivor group) and did not occur in 89 (67.94%) patients (survivor group). The median BUN (mg/dL) and BAR (mg/gm) values were significantly raised in the non-survivor group than in the survivor group [BUN: 23.48 (7.51-62.75) and 20.66 (4.07-74.67), respectively (p = 0.009); BAR: 8.33 mg/g (2.07-21.86) and 6.11 mg/g (1.26-23.33); (p = 0.0003)]. The mean albumin levels (gm/dL) in the non-survivor group were significantly lower than in the survivor group [2.96 ± 0.35 and 3.27 ± 0.35, respectively (p <0.0001)]. Albumin with an odd's ratio of 6.14 performed the best in predicting in-hospital mortality, followed by D-dimer (4.98). BAR and CRP had similar outcome of 3.75; BUN showed an OR of 3.13 at the selected cutoff value. Conclusion: The BUN, albumin, and BAR were found to be dependable predictors of in-hospital mortality in COVID-19 patients, with albumin (hypoalbuminemia) performing even better. How to cite this article: Singh S, Singh K. Blood Urea Nitrogen/Albumin Ratio and Mortality Risk in Patients with COVID-19. Indian J Crit Care Med 2022;26(5):626-631.

Painful Blisters of Left Hand Following Extravasation of Remdesivir Infusion in COVID-19.

How to cite this article: Kumar N, Kumar A, Pradhan S, Kumar A, Singh K. Painful Blisters of Left Hand Following Extravasation of Remdesivir Infusion in COVID-19. Indian J Crit Care Med 2021;25(2):240-241.

NUTRIC score as a predictor of outcome in COVID-19 ARDS patients: A retrospective observational study.

BACKGROUND AND AIMS: The Nutrition Risk in Critically ill (NUTRIC) score is an appropriate nutritional assessment tool in mechanically ventilated patients. We retrospectively observed the applicability of the NUTRIC score for predicting outcomes in coronavirus disease (COVID)-19 acute respiratory distress syndrome (ARDS) patients. METHODS: All adult COVID-19 ARDS patients admitted to the intensive care unit and requiring various forms of oxygen therapy were included in the study. The demographic characteristics and clinical information about the patients were obtained from the hospital's medical records department. The nutritional risk for each patient was assessed using the NUTRIC score at 72 hours of ICU admission. The discriminating power and ability of NUTRIC score, Sequential Organ Failure Assessment (SOFA) score, age and Acute Physiology and Chronic Health Evaluation (APACHE) II to predict the 28-day mortality and need for mechanical ventilation (MV) was calculated using receiver operating characteristic curves and area under this curve. RESULTS: A total of 80 COVID-19 ARDS patients fitted into the inclusion criteria. Among non-survivors, the median Glasgow Coma Score, APACHE II score, NUTRIC score and SOFA score were 10, 16, 6 and 4, respectively. The cut-off values for NUTRIC score, SOFA, and APACHE II to predict 28-day mortality and need for MV was obtained as 3.5, 3.5 and 11.5, respectively. These cut-off values of NUTRIC score, SOFA score, and APACHE II have a sensitivity of 62%, 72.5% and 75.5%, respectively, and specificity of 95%, 72% and 83% for predicting mortality. CONCLUSIONS: Most COVID-19 ARDS patients requiring MV in the ICU are at nutritional risk, and a high NUTRIC score is associated with higher mortality.

Dual Oxygen Therapy in COVID-19 Patient: A Method to Improve Oxygenation.

Approximately 5-6% of patients diagnosed to have COVID-19 infection present with severe hypoxemia requiring invasive ventilation or non-invasive ventilation (NIV). Additional oxygen to patients on NIV can be given by nasal prong or by connecting oxygen tubing directly to the O2 pick-off port of the NIV mask or by connecting oxygen tubing to the single-limb circuit in between ventilator and patient. Dual oxygen therapy improves oxygenation in COVID-19 patients on NIV. This method may make the patient more comfortable, increase tolerance to NIV, increase the usefulness of NIV for moderate and severe COVID-19 acute respiratory distress syndrome (ARDS). How to cite this article: Kumar A, Kumar A, Sinha C, Kumar N, Singh K, Singh PK. Dual Oxygen Therapy in COVID-19 Patient: A Method to Improve Oxygenation. Indian J Crit Care Med 2021;25(2):231-233.

Influenza risk perception and travel-related health protection behavior in the US: Insights for the aftermath of the COVID-19 outbreak.

Influenza is a contagious virus affecting both one's health and economic productivity. This study evaluates uses a survey of 2168 individuals across the U.S. Ordered logit regressions are used to model risk perception and generalized ordered logit regressions are used to model risk mitigation travel-related decisions. Models are estimated for three influenza outbreak scenarios, specifically an individual's travel-related: 1) risk perceptions, 2) risk mitigation decisions when infected and the individual wants to prevent spreading it, and may want treatment, and 3) risk mitigation decisions when not infected and the individual wants to reduce exposure. Risk perception results show that a recent personal experience with influenza-like symptoms and being female significantly increased risk perception at mandatory and medical trip locations. Risk mitigation model results show that males are less likely to alter their travel patterns in response to the possible spreading of the virus or increasing exposure. Knowing the difference between influenza and the stomach flu is more influential in reducing travel than a recent influenza experience in one's household. Individuals proactive with their health (i.e., receive the vaccine, have health insurance) are also proactive in seeking medical attention and reducing influenza spread. Lastly, aligned with the Protection Motivation Theory, individuals reduce travel to locations in which they perceived medium or high risk. However, increased risk perceived at one's work location did not significantly reduce travel. The findings provide insight into the risk perception and mitigation behavior of the American public during the COVID-19 pandemic and after restrictions are lifted.