ABSTRACT
OBJECTIVE: To develop predictive models for in-hospital mortality and length of stay (LOS) for coronavirus disease 2019 (COVID-19)-positive patients. PATIENTS AND METHODS: We performed a multicenter retrospective cohort study of hospitalized COVID-19-positive patients. A total of 764 patients admitted to 14 different hospitals within the Cleveland Clinic from March 9, 2020, to May 20, 2020, who had reverse transcriptase-polymerase chain reaction-proven coronavirus infection were included. We used LightGBM, a machine learning algorithm, to predict in-hospital mortality at different time points (after 7, 14, and 30 days of hospitalization) and in-hospital LOS. Our final cohort was composed of 764 patients admitted to 14 different hospitals within our system. RESULTS: The median LOS was 5 (range, 1-44) days for patients admitted to the regular nursing floor and 10 (range, 1-38) days for patients admitted to the intensive care unit. Patients who died during hospitalization were older, initially admitted to the intensive care unit, and more likely to be white and have worse organ dysfunction compared with patients who survived their hospitalization. Using the 10 most important variables only, the final model's area under the receiver operating characteristics curve was 0.86 for 7-day, 0.88 for 14-day, and 0.85 for 30-day mortality in the validation cohort. CONCLUSION: We developed a decision tool that can provide explainable and patient-specific prediction of in-hospital mortality and LOS for COVID-19-positive patients. The model can aid health care systems in bed allocation and distribution of vital resources.
ABSTRACT
INTRODUCTION: Alcohol-containing hand sanitizers are part of the strategy to prevent person-to-person transmission during the COVID-19 pandemic. The purpose of this report was to present a case of ethanol-induced hand sanitizer intoxication after spine surgery in a patient with a postoperative delirious state. PRESENTATION OF CASE: A 63-year-old man was admitted to the spine department with intractable back pain as the main symptom and diagnosed with infectious spondylitis with discitis. The patient suddenly showed mental changes, resulting in a semi-comatose mental state the first day after surgery, without seizure-like activity and asphyxia. We subsequently discovered the patient had consumed half of an ethanol hand sanitizer bottle (about 300-400 mL) which was placed at the foot of the bed to prevent infection transmission during the COVID-19 pandemic. The patient did not tend to depend on alcohol or psychiatric medication in the past, and had no addiction. After seven months, the patient had complete bone union and independent ambulation. DISCUSSION: Acute ethanol intoxication can result in life-threatening clinical effects. One of the major problems after orthopedic surgery is delirium, with the largest number appearing after spine surgery. CONCLUSION: Hand sanitizer, mainly composed of ethanol, did not cause abnormal findings or interfere with the course of treatment of infectious spondylitis. However, it is expected that such accidents will increase, due to the increase in the use of hand sanitizers caused by COVID-19. It is, therefore, necessary to avoid potential patient abuse, especially after spinal surgery in patients at risk of delirium.