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BACKGROUND: Conceptual models are abstract representations of the real world. They are used to refine medical and nonmedical health care scopes of service. During the COVID-19 pandemic, numerous analytic predictive models were generated aiming to evaluate the impact of implemented policies on mitigating the spread of the virus. The models also aimed to examine the psychosocial factors that might govern the general population's adherence to these policies and to identify factors that could affect COVID-19 vaccine uptake and allocation. The outcomes of these analytic models helped set priorities when vaccines were available and predicted readiness to resume non-COVID-19 health care services. OBJECTIVE: The objective of our research was to implement a descriptive-analytical conceptual model that analyzes the data of all COVID-19-positive cases admitted to our hospital from March 1 to May 31, 2020, the initial wave of the pandemic, the time interval during which local policies and clinical guidelines were constantly updated to mitigate the local effects of COVID-19, minimize mortality, reduce intensive care unit (ICU) admission, and ensure the safety of health care providers. The primary outcome of interest was to identify factors that might affect mortality and ICU admission rates and the impact of the implemented policy on COVID-19 positivity among health care providers. The secondary outcome of interest was to evaluate the sensitivity of the COVID-19 visual score, implemented by the Saudi Arabia Ministry of Health for COVID-19 risk assessment, and CURB-65 (confusion, urea, respiratory rate, blood pressure, and age >65 years) scores in predicting ICU admission or mortality among the study population. METHODS: This was a cross-sectional study. The relevant attributes were constructed based on research findings from the first wave of the pandemic and were electronically retrieved from the hospital database. Analysis of the conceptual model was based on the International Society for Pharmacoeconomics and Outcomes Research guidelines and the Society for Medical Decision-Making. RESULTS: A total of 275 individuals tested positive for COVID-19 within the study design interval. The conceptualization model revealed a low-risk population based on the following attributes: a mean age of 42 (SD 19.2) years; 19% (51/275) of the study population being older adults ≥60 years of age; 80% (220/275) having a CURB-65 score <4; 53% (147/275) having no comorbidities; 5% (13/275) having extreme obesity; and 20% (55/275) having a significant hematological abnormality. The overall rate of ICU admission for the study population was 5% (13/275), and the overall mortality rate was 1.5% (4/275). The multivariate correlation analysis revealed that a high-selectivity approach was adopted, resulting in patients with complex medical problems not being sent to MOH isolation facilities. Furthermore, 5% of health care providers tested positive for COVID-19, none of whom were health care providers allocated to the COVID-19 screening areas, indicating the effectiveness of the policy implemented to ensure the safety of health care providers. CONCLUSIONS: Based on the conceptual model outcome, the selectivity applied in retaining high-risk populations within the hospital might have contributed to the observed low mortality rate, without increasing the risk to attending health care providers.
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Background: The COVID-19 pandemic continues with new waves that could persist with the arrival of new SARS-CoV-2 variants. Therefore, the availability of validated and effective triage tools is the cornerstone for proper clinical management. Thus, this study aimed to assess the validity of the ISARIC-4C score as a triage tool for hospitalized COVID-19 patients in Saudi Arabia and to compare its performance with the CURB-65 score. Material and methods: This retrospective observational cohort study was conducted between March 2020 and May 2021 at KFHU, Saudi Arabia, using 542 confirmed COVID-19 patient data on the variables relevant to the application of the ISARIC-4C mortality score and the CURB-65 score. Chi-square and t-tests were employed to study the significance of the CURB-65 score and the ISARIC-4C score variables considering the ICU requirements and the mortality of COVID-19 hospitalized patients. In addition, logistic regression was used to predict the variables related to COVID-19 mortality. In addition, the diagnostic accuracy of both scores was validated by calculating sensitivities, specificities, positive predictive value, negative predictive value, and Youden's J indices (YJI). Results: ROC analysis showed an AUC value of 0.834 [95% CI; 0.800-0.865]) for the CURB-65 score and 0.809 [95% CI; 0.773-0.841]) for the ISARIC-4C score. The sensitivity for CURB-65 and ISARIC-4C is 75% and 85.71%, respectively, while the specificity was 82.31% and 62.66%, respectively. The difference between AUCs was 0.025 (95% [CI; -0.0203-0.0704], p = 0.2795). Conclusion: Study results support external validation of the ISARIC-4C score in predicting the mortality risk of hospitalized COVID-19 patients in Saudi Arabia. In addition, the CURB-65 and ISARIC-4C scores showed comparable performance with good consistent discrimination and are suitable for clinical utility as triage tools for hospitalized COVID-19 patients.
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Background: In respiratory infections, anemia is both a consequence of acute inflammation [1] and a predictor [2] of poor clinical outcomes. There are few studies investigating the role of anemia in COVID-19, suggesting a potential role in predicting disease severity [3, 4]. In this study, we aimed to assess the association between the presence of anemia at admission and incidence of severe disease and death in patients hospitalized for COVID-19. Method(s): Data from all adult patients admitted for COVID-19 in University Hospital P. Giaccone (Palermo) and University Hospital of Bari, Italy, were retrospectively collected from 1st of September 2020 and 31 August 2022. The association between anemia (defined as Hb < 13 g/dl and < 12 g/dl in males and females, respectively), in-hospital mortality and severe COVID-19 was tested using a Cox's regression analysis. Severe COVID-19 forms were defined as admission to intensive or sub-intensive care unit or a qSOFAscore >=2 or CURB65scores >=3. P values were calculated using the Student's T-test for continuous variables and the Mantel-Haenszel Chi-square test for categorical ones. The association between anemia and the mortality was made using a Cox's regression analysis, adjusted, in two models, for the potential confounders and using a propensity score. Result(s): Among the 1562 patients included in the analysis, prevalence of anemia was 45.1% (95%CI 43-48%), and as shown in Table 1, were significantly older (p< 0.0001), reported more co- morbidities, and presented higher baseline levels of procalcitonin, CRP, ferritin and IL-6. As shown in Figure 1, patients with anemia reported a higher crude higher incidence of mortality compared to patients without this condition (Figure 1). Overall, the crude incidence of mortality was about four times higher in patients with anemia compared to those without. After adjusting for 17 potential confounders, the presence of anemia significantly increased the risk of death (HR=2.68;95%CI: 1.59-4.52) and of risk of severe COVID-19 (OR=2.31;95%CI: 1.65-3.24) (Table 2). The propensity score analysis substantially confirmed these analyses. Conclusion(s): Our study provides evidence that, in patients hospitalized for COVID-19, anemia is both associated with a more pronounced baseline proinflammatory profile and higher incidence of in-hospital mortality and severe disease.
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Background: SARS-CoV-2 has emerged as a novel pathogen of community-acquired pneumonia (CAP). Aims and objectives: We aimed to compare characteristics, clinical outcomes and pneumococcal identification in patients with COVID-19 vs non-COVID-19 CAP. Method(s): EGNATIA is an ongoing, prospective study of adults >=19yo hospitalized with clinical and radiographicallyconfirmed CAP in Greece. The primary objective is to estimate the proportion of CAP due to pneumococcal serotypes included in 13-valent pneumococcal conjugate vaccine (PCV13). Pneumococcus was identified using serotype-specific urinary antigen detection assays (UAD 1/2), BinaxNow and conventional cultures. Testing for SARS-CoV-2 was performed as per national guidelines. Result(s): We compared 202 patients with COVID-19 pneumonia during Apr2020-Mar2021 vs 1033 patients with nonCOVID-19 CAP during Nov2017-Oct2020. Patients with COVID-19 were younger (median age 68.8 vs 75.8 years) and had fewer comorbidities (67.8% with >=1 underlying condition vs 79.2%) than non-COVID-19 patients. Patients with COVID-19 less frequently reported past pneumonia episodes (0.5% vs 7.7%) but were more frequently nursing home residents (13.9% vs 6%). Patients with COVID-19 had less severe pneumonia presentation (CURB 65 3-5 6.4% vs 30.5%;PSI IV-V 41.1% vs 55.2%) but required mechanical ventilation more frequently (7.4% vs 1.9%) and had a longer hospital stay (mean 17.4 vs 9.6 days). In-hospital mortality was similar between the 2 groups (7.9% in COVID-19 vs 8.9% in non-COVID-19). Pneumococcus was identified less frequently in patients with COVID-19 vs non-COVID-19 CAP (4% vs 11.1%). Conclusion(s): Significant differences were identified in patients with COVID-19 vs non-COVID-19 CAP.
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Introduction: COVID-19, as of 9 June 2020, had been responsible for 404,396 deaths worldwide. Throughout the pandemic, IRCU and ICU directly cared for patients with severe or very severe respiratory failure due to COVID19 pneumonia. Objective(s): To determine if N-acetyl-cysteine (NAC) could be associated with lower mortality risk. Methodology: 1141 patients from March to May 2020 admitted to the ICU and IRCU of the Fundacion Jimenez Diaz were analysed. Patients with <3 days of hospital admission and those with CURB-65 equal to or <0 were excluded. A multivariate regression logistics models have been used to respond to our hypothesis and investigate the relationship between each variable and the mortality. Result(s): Of all patients analyzed, 44% received treatment with NAC associated with other drugs according to established protocols. Of these, 55% were male, most non-smokers with a mean age of 74.43 years. In table 2 we describe statistically significant predictive parameters associated with a decreased risk of mortality in severe or very severe patients with an area AUC of 0.80 Conclusion(s): Adjuvant treatment with NAC in severe or very severe COVID-19 pneumonia is associated with a significantly lower risk of mortality by 30% in elderly patients, principally males, and with associated co-morbidities.
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Introduction: COVID19 can cause neutrophilic inflammation and reaction oxygen species (ROS) production, leading to acute lung injury and mortality. AMPK is a key regulator of cellular energy with profound effects on neutrophil function. This study aims to investigate the role of AMPK activity in neutrophils during COVID-19 and pneumonia caused by pathogens other than SARS-CoV-2. Method(s): Patients hospitalised due to pneumonia or COVID-19 were recruited from Ninewells Hospital (Dundee, UK). Blood was sampled at day 1, 8, and 15. ROS production, phospho-AMPK (pAMPK), and NQO1 were stained in neutrophils, and then analysed by flow cytometry. The endogenous AMPK inhibitor, resistin, was quantified by ELISA, in serum (day 1, 8, 15). WHO clinical scale and CURB65 score were utilised to define severity. Result(s): 133 patients were enrolled (mean age 63.6 years). Resistin was not different between pneumonia and COVID-19 on day1. However, day 1 resistin was higher in severe disease defined by CURB65 Score (p=0.0220) and WHO score (p=0.0184). Resistin reduced over time at day 1 (mean 63.1pg/mL;n=121) to day 15 (mean 59.5pg/mL;n=66)(p=0.0002). Zymosan stimulation significantly increases neutrophil ROS production (p<0.0001), and significantly decreases NQO1 (p<0.0001), but caused no changes with pAMPK. There were no changes in these markers over time. pAMPK significantly correlated with NQO1 in unstimulated neutrophils (p=0.0388), but not when stimulated with zymosan. There were no associations between resistin and pAMPK, and no difference in these markers between pneumonia and COVID-19 groups. Conclusion(s): Our study suggests resistin as a marker of severity and disease course in COVID-19, independent of neutrophil AMPK signalling.
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Background: Predicting the severity of COVID-19 infection in advance is the key to success of its treatment outcome. Various scoring systems are used to detect the severity of this disease but this study targets three simple scoring systems based on the vital parameters and basic routine laboratory tests. Aims and Objectives: The aim of the study was to assess the predictability of three scoring systems (Quick sequential organ failure assessment [q SOFA], CURB-65, and Early Warning scoring system) for disease severity at presentation in a rural-based tertiary care center. Material(s) and Method(s): An observational, descriptive, retrospective, and cross-sectional study was conducted at Diamond Harbour Government Medical College Covid Hospital from January 2021 to January 2022 to assess the predictability of q SOFA, CURB-65, and Early Warning scoring system for disease severity at presentation. Result(s): The total number of participants was 561 among total admitted 1367 patients. A short descriptive analysis obtained from the variables to analyze the scorings showed among total sample collected, 57% were male and 43% were female. In this study, 87% of patients were survived and the rest 13% succumbed (death). There is no statistically significant difference in mortality between both genders. Age, pulse rate, and respiratory rate have a significant correlation with the outcome and altered sensorium is also highly associated with mortality. The accuracy was also found to be little higher for National Early Warning score (NEWS) score than CURB-65 scoring and q SOFA scoring (0.919, 0.914 and 0.907). Although all the scoring systems have high sensitivity (>90%) (CURB 65: Most sensitive [0.99]), the specificities of all three scoring systems are below 50%. Among these three-scoring systems, NEWS showed the highest specificity (0.492) than q SOFA (0.423) and CURB 65 (0.394). Conclusion(s): We suggest NEWS score and CURB-65 as a better predictor for in-hospital mortality in COVID-19 patients as it is significantly sensitive and reasonably specific. It can be recommended in less equipped hospitals where only basic laboratory facilities are available. qSOFA can be utilized where no laboratory facility is available like in safe home and isolation centers.Copyright © 2023, Mr Bhawani Singh. All rights reserved.
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Background: Coronavirus disease 2019 (COVID-19) pandemic has changed the inpatient practice of bacterial pneumonia. On hospitalization, isolation is required while waiting for the result of the PCR test, which may lead to limited access to medical resources and fewer rounds by medical staff. However, little is known about the relationship of isolation with the clinical outcomes of bacterial pneumonia. Here we hypothesized that isolation for COVID-19 suspected patients, who were eventually diagnosed with bacterial pneumonia, is associated with longer hospital stays, compared to no isolation. Method(s): This is a single center retrospective observational study of hospitalized adult patients diagnosed with bacterial pneumonia, from January 2018 to September 2021. The patients were divided into the non-isolated group (patients hospitalized between January 2018 to December 2019, who were not isolated at all), and the isolated group (patients hospitalized between January 2020 to September 2021, who were isolated because COVID-19 was suspected). The primary outcome was longer hospital stays (hospital stays >=14 days) and its relation to isolation was analyzed, using logistic regression analysis, adjusted for age, sex, the CURB-65, and the Charlsons Comorbidity Index. Result(s): Among 917 eligible patients, 214 (23%) underwent isolation. In logistic regression analysis, the isolated group resulted in independently longer hospital stays, compared to the non-isolated group (OR 1.49;95%CI 1.082.07, p=0.015). There was no significant difference in antibiotic duration between two groups. Conclusion(s): The isolation of bacterial pneumonia patients suspected of COVID-19 was associated with longer hospital stays.
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Aim: In this study, we aimed to analyze the relationship between pulmonary artery (PA) and inferior vena cava (IVC) diameters in non-contrast chest computerized tomography (CT) images of patients with coronavirus disease 2019 (COVID-19) and overall survival. Material(s) and Method(s): This retrospective study consisted of 404 consecutive patients who underwent chest CT after admission to the emergency department between May 1 and June 31, 2021. CT measurements were performed by two radiologists. The prognostic value of PA and IVC diameters, the computerized tomography severity score (CT-SS), quick sequential organ failure assessment (qSOFA), and confusion, urea, respiratory rate, blood pressure, and age >=65 years (CURB-65) score on overall survival were examined. Result(s): The median age of the participants was 62 years (49-72), and 196 (48.5%) were male. Of the 404 patients, 61 died after admission. While main-PA, left-PA, right-PA (p < 0.001) and IVC-transverse (IVC-Tr) (p = 0.045) diameters were larger and statistically significant in the patients who died (AUC;0.686, 0.722, 0.746, and 0.581, respectively), a statistically significant difference was not detected in terms of IVC anteroposterior diameter (IVC-AP) (p = 0.053) and the IVC-Tr/AP (p = 0.754) ratio. There was a statistical difference in mortality in qSOFA, CURB-65, and CT-SS values (AUC;0.727, 0.798, and 0.708 p < 0.001, respectively). Discussion(s): PA diameters measured from chest CT images at admission (main-PA >= 26.5 mm, right-PA >= 22.9 mm, and left-PA >= 21.6 mm) and the IVC-Tr diameter (>=34.5 mm) can be used as mortality predictors for COVID-19, along with other prognostic scores.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Introduction: The transcription factor Nrf2 downregulates key inflammatory cytokines in COVID-19 (IL-6, IL-1b, COX-2 and TNF-a). We investigated the efficacy of S-SFN (stabilised sulforaphane, activator of Nrf2) to improve clinical outcomes in patients hospitalized with suspected COVID-19. Method(s): Randomized, double-blind, placebo-controlled trial, patients hospitalised with suspected or confirmed COVID-19, radiological pneumonia and a CURB65 score of >= 1 were randomized 1:1 to once-daily S-SFN 300mg or placebo for 14 days. The primary outcome was the 7-point WHO Clinical Status (CS) scale at day 15. Key secondary outcomes included time to clinical improvement, national early warning score (NEWS), oxygen and ventilation use, and mortality. Result(s): The trial was terminated due to futility after 133 patients had been enrolled (S-SFN, n=65 and placebo, n=68). 103 had PCR confirmed COVID-19 infection. S-SFN treatment was not associated with improved CS at day 15 (OR 0.87 95%CI (0.41-1.83, p=0.712). There was no difference in time to clinical improvement (HR 1.02 (0.70- 1.49)). S-SFN was not associated with a reduced length of hospital stay (6.2days vs 7.4days (S-SFN)). There were 26 deaths during the 29-day follow-up, 11 (16.2%) and 15 (23.1%) patients died in the placebo and S-SFN treated groups respectively (HR 1.45 (0.67-3.16)). There were no differences between treatment groups with respect to oxygen or ventilation free days. Adverse events were reported in 44.1% of placebo treated and 64.6% of S-SFN treated patients. Conclusion(s): S-SFN treatment did not improve day 15 clinical status in hospitalized patients with suspected or confirmed COVID-19 infection.
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Aim: In this study, we aimed tto compare the 30-day mortality prediction abilities of the acute physiology and chronic health evaluation II (APACHE II), CURB-65, pneumonia severity index (PSI), A-DROP, Infectious Diseases Society of America/American Thoracic Society severity criteria, and I-ROAD scores in patients aged over 80 years admitted to the intensive care unit with COVID-19 pneumonia. Material(s) and Method(s): The study was conducted with a single-center retrospective observational design and included patients aged 80 years and older who were admitted to the intensive care unit due to COVID-19 pneumonia between March 2020 and August 2021. Patient demographic data, imaging findings, blood test results, discharge status, length of stay in the intensive care unit, duration of mechanical ventilation, inotropic drug administration status, presence/ absence of mortality and vital signs at the time of admission were obtained from the hospital automation system. Then, the above-mentioned scores were calculated and compared statistically. Result(s): The study was completed with 119 patients, 60 (50.4%) women and 59 (49.6%) men. The mean age of all patients was 84 (80-98) years, and the mortality rate was 84.03% (n=100). Among the scoring systems, I-ROAD had the highest area under the curve (AUC) value (0.703), APACHE II had the highest specificity (94%), and A-DROP had the highest sensitivity (64%). Discussion(s): According to our results, the I-ROAD scoring system is an effective tool that can be used in the prediction of mortality related to COVID-19 pneumonia among intensive care patients aged >=80.Copyright © 2023, Derman Medical Publishing. All rights reserved.
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Objectives: Coronavirus disease-2019 (COVID-19) disease has overwhelmed the healthcare infrastructure worldwide. The shortage of intensive care unit (ICU) beds leads to longer waiting times and higher mortality for patients. High crowding leads to an increase in mortality, length of hospital stays, and hospital costs for patients. Through an appropriate stratification of patients, rational allocation of the available hospital resources can be accomplished. Various scores for risk stratification of patients have been tried, but for a score to be useful at primary care level, it should be readily available at the bedside and be reproducible. ROX index and CURB-65 are simple bedside scores, requiring minimum equipment, and investigations to calculate. Methods: This retrospective, record-based study included adult patients who presented to the ED from May 1, 2020 to November 30, 2020 with confirmed COVID-19 infection. The patient's clinical and demographic details were obtained from the electronic medical records of the hospital. ROX index and CURB-65 score on ED arrival were calculated and correlated with the need for hospitalization and early (14-day) and late (28-day) mortality. Results: 842 patients were included in the study. The proportion of patients with mild, moderate and severe disease was 46.3%, 14.9%, and 38.8%, respectively. 55% patients required hospitalization. The 14-day mortality was 8.8% and the 28-day mortality was 20.7%. The AUROC of ROX index for predicting hospitalization was 0.924 (p < 0.001), for 14-day mortality was 0.909 (p < 0.001) and for 28-day mortality was 0.933 (p < 0.001). The AUROC of CURB-65 score for predicting hospitalization was 0.845 (p < 0.001), for 14-day mortality was 0.905 (p < 0.001) and for 28-day mortality was 0.902 (p < 0.001). The cut-off of ROX index for predicting hospitalization was ≤18.634 and for 14-day mortality was ≤14.122. Similar cut-off values for the CURB-65 score were ≥1 and ≥2, respectively. Conclusion: ROX index and CURB-65 scores are simple and inexpensive scores that can be efficiently utilised by primary care physicians for appropriate risk stratification of patients with COVID-19 infection.
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Introduction: The acute physiology and chronic health evaluation (APACHE), sepsis-related organ failure assessment (SOFA), score for pneumonia severity (CURB-65) scales, a low phase angle (PA) and low muscle strength (MS) have demonstrated their prognostic risk for mortality in hospitalized adults. However, no study has compared the prognostic risk between these scales and changes in body composition in a single study in adults with SARS-CoV-2 pneumonia. The great inflammation and complications that this disease presents promotes immobility and altered nutritional status, therefore a low PA and low MS could have a higher prognostic risk for mortality than the scales. The aim of the present study was to evaluate the prognostic risk for mortality of PA, MS, APACHE, SOFA, and CURB-65 in adults hospitalized with SARS-CoV-2 pneumonia. Methodology: This was a longitudinal study that included n = 104 SARS-CoV-2-positive adults hospitalized at General Hospital Penjamo, Guanajuato, Mexico, the PA was assessed using bioelectrical impedance and MS was measured with manual dynamometry. The following disease severity scales were applied as well: CURB-65, APACHE, and SOFA. Other variables analyzed were: sex, age, CO-RADS index, fat mass index, body mass index (BMI), and appendicular muscle mass index. A descriptive analysis of the study variables and a comparison between the group that did not survive and survived were performed, as well as a Cox regression to assess the predictive risk to mortality. Results: Mean age was 62.79 ± 15.02 years (31-96). Comparative results showed a mean PA of 5.43 ± 1.53 in the group that survived vs. 4.81 ± 1.72 in the group that died, p = 0.030. The mean MS was 16.61 ± 10.39 kg vs. 9.33 ± 9.82 in the group that died, p = 0.001. The cut-off points for low PA was determined at 3.66° and ≤ 5.0 kg/force for low grip strength. In the Cox multiple regression, a low PA [heart rate (HR) = 2.571 0.726, 95% CI = 1.217-5.430] and a low MS (HR = 4.519, 95% CI = 1.992-10.252) were associated with mortality. Conclusion: Phase angle and MS were higher risk predictors of mortality than APACHE, SOFA, and CURB-65 in patients hospitalized for COVID-19. It is important to include the assessment of these indicators in patients positive for SARS-CoV-2 and to be able to implement interventions to improve them.
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Background: A coronavirus pandemic (COVID-19) is associated with catastrophic effects on the world with high morbidity and mortality. We aimed to evaluate the accuracy of physiological shock index (SIPF) (shock index and hypoxemia), CURB -65, acute physiology, and chronic health assessment II (APACHE II) as predictors of prognosis and in-hospital mortality in patients with COVID-19 pneumonia. Methods: In Saudi Arabia, a multicenter retrospective study was conducted on hospitalized adult patients confirmed to have COVID-19 pneumonia. Information needed to calculate SIPF, CURB-65, and APACHE II scores were obtained from medical records within 24 hours of admission. Results: The study included 1131 COVID-19 patients who met the inclusion criteria. They were divided into two groups: (A) the ICU group (n=340; 30.1%) and (B) the ward group (n=791; 69.9%). The most common concomitant diseases of patients at initial ICU admission were hypertension (71.5%) and diabetes (62.4%), and most of them were men (63.8%). The overall mortality was 18.7%, and the mortality rate was higher in the ICU group than in the ward group (39.4% vs 9.6%; p < 0.001). The SIPF score showed a significantly higher ability to predict both ICU admission and mortality in patients with COVID-19 pneumonia compared with APACHE II and CURB -65; (AUC 0.89 vs 0.87; p < 0.001) and (AUC 0.89 vs 0.84; p < 0.001) for ICU admission and (AUC 0.90 vs 0.65; p < 0.001) and (AUC 0.90 vs 0.80; p < 0.001) for mortality, respectively. Conclusion: The ability of the SIPF score to predict ICU admission and mortality in COVID-19 pneumonia is higher than that of APACHE II and CURB-65. The overall mortality was 18.7%, and the mortality rate was higher in the ICU group than in the ward group (39.4% vs 9.6%; p < 0.001).
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Some of the patients with COVID-19 pneumonia are followed up in intensive care units (ICU). This study aimed to determine the success of intensive care scores used in patients followed up in the ICU with the diagnosis of COVID-19 pneumonia in predicting morbidity and mortality. This retrospective study included patients treated for COVID-19 pneumonia in the ICUs of Samsun Training and Research Hospital. We used the patients' demographic characteristics, vital signs, arterial blood gas values, radiological imaging, and laboratory data by using the hospital database and patient files. Group I was composed of alive patients, while Group II was of dead ones. A total of 75 patients were included in the study, of which 34 (45.3%) were female and 41 (54.7%) were male. The median length of intensive care stay was 8 (5-15) days in Group I patients and 5 (2-8) days in Group II patients, which was higher in alive patients (p=0.004). Radiological involvement was present in 93.3% (n=70) of the patients, and involvement was observed in both lungs in 77.3% (n=58). We observed complications in 54.7% (n=41) of the patients, whereas the incidence of complications was 20% in Group I and 72% in Group II, which was statistically significant (p<0.001). APACHE II, PSI, SOFA, qSOFA, SMART-COP, CURB65, A-DROP and NEWS2 scores were statistically significantly higher in patients who died, whereas APACHE II, SOFA, qSOFA, and SMART-COP scores were more successful in predicting morbidity. It is vital to predict the mortality risk early in patients with COVID-19 pneumonia followed up in intensive care units. Among the scoring systems, APACHE II, PSI, SOFA, qSOFA, SMART-COP, CURB65, A-DROP, and NEWS2 can be used safely to predict mortality. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.
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This study aims to evaluate the ability of physicians' predictions to predict mortality in COVID-19 patients and compare physician predictions with scores developed for COVID-19 patients in predicting mortality and patient worsening. This study was conducted prospectively in the emergency department. Patient data were collected between 20.03.2021 and 20.06.2021. Patients who applied to our hospital with COVID-19 symptoms and were confirmed to be COVID-19 by rt-PCR results were included in our study. Patients aged 18 years and over who were tr-PCR positive were included in the study. Quick COVID-19 Severity Index (qCSI), Brescia-COVID Respiratory Severity Scale (BCRSS), and CURB-65 scale were calculated and recorded by a researcher. A total of 176 patients were included in our study. There was no significant relationship between physicians' gestalt and 28-day mortality (p=0.121, p=0.282, Mann-Whitney U Test, respectively). Physicians' gestalt was found to be insufficient to predict mortality in COVID-19 patients. There was a significant difference between the CURB-65 short-term mortality group and the survivors. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.
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Background: Thrombosis is among the most prominent and concerning complications associated with COVID-19. These thrombotic events have been associated in progression of ARDS and morbidity and mortality. Methodology: Retrospective cohort study of 203 patients>=18 years old with confirmed COVID-19 admitted on tertiary referal hospital from January to December 2021. All thrombotic events were established by clinical signs and symptoms, ultrasonography and CT scan. Result(s) and Conclusion(s): Sixty five (32%) patients out of 203 developed thrombotic complications. The most common thrombotic event was pulmonary embolism (36%), followed by myocardial infarction (28%), cerebrovascular infarct (27%), DVT (25%), acute limb ischemia (7%) and lastly, mesenteric ischemia (6%). There were significant differences in demographic and clinical profile among COVID-19 patients with and without thrombotic events. Thrombosis was more commonly seen in advanced age (>=75 years, 49.2% vs. 23.9%;RR2.06, CI1.4-3.03), severe infection (severe, 24.6% vs. 19.6%;RR1.2, CI0.8-1.9 and critical and 47.7% vs. 10.1%;RR3.2, CI2.2-4.6, respectively), ICU admission (20% vs. 3.6%;RR2.6, CI1.8-3.7). Other complications were acute respiratory syndrome (83% vs. 43.5%;RR3.8, CI2.1-6.9), acute kidney injury (50.8% vs. 19.6%;RR2.46, CI1.68-3.6), major bleeding (9.2% vs. 0%;RR2.07, CI1.83-2.34), clinically relevant non-major bleeding (30.8% vs. 10.1%;RR2.21, CI1.52-3.22), hospitalization>21 days (29.2% vs. 13%;RR1.85, CI1.24-2,76), and all-cause mortality (60% vs. 3.6%;RR5.42, CI3.76-7.82). Patients who developed thrombosis had prolonged duration of immobilization, higher Padua prediction and CURB 65 scores, with wall motion abnormality in 2D-echocardiography, elevated D-dimer and pro-BNP, reduced oxygen saturation an often received invasive and non-invasive ventilation and hemoperfusion. Majority of patients was given thromboprophylaxis in both groups;hence a significant difference was not found. An institutional thromboprophylaxis protocol is needed in managing COVID-19 patients at risk for thrombotic events.
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OBJECTIVES: To validate and recalibrate the CURB-65 and pneumonia severity index (PSI) in predicting 30-day mortality and critical care intervention (CCI) in a multiethnic population with COVID-19, along with evaluating both models in predicting CCI. METHODS: Retrospective data was collected for 1181 patients admitted to the largest hospital in Qatar with COVID-19 pneumonia. The area under the curve (AUC), calibration curves, and other metrics were bootstrapped to examine the performance of the models. Variables constituting the CURB-65 and PSI scores underwent further analysis using the Least Absolute Shrinkage and Selection Operator (LASSO) along with logistic regression to develop a model predicting CCI. Complex machine learning models were built for comparative analysis. RESULTS: The PSI performed better than CURB-65 in predicting 30-day mortality (AUC 0.83, 0.78 respectively), while CURB-65 outperformed PSI in predicting CCI (AUC 0.78, 0.70 respectively). The modified PSI/CURB-65 model (respiratory rate, oxygen saturation, hematocrit, age, sodium, and glucose) predicting CCI had excellent accuracy (AUC 0.823) and good calibration. CONCLUSIONS: Our study recalibrated, externally validated the PSI and CURB-65 for predicting 30-day mortality and CCI, and developed a model for predicting CCI. Our tool can potentially guide clinicians in Qatar to stratify patients with COVID-19 pneumonia.
Subject(s)
COVID-19 , Community-Acquired Infections , Pneumonia , Critical Care , Hospital Mortality , Humans , Pneumonia/diagnosis , Pneumonia/therapy , Prognosis , Retrospective Studies , SARS-CoV-2 , Severity of Illness IndexABSTRACT
INTRODUCTION: The novel coronavirus disease 2019 (COVID-19) has been a major health concern worldwide. This study aims to develop a Bayesian model to predict critical outcomes in patients with COVID-19. METHODS: Sensitivity and specificity were obtained from previous meta-analysis studies. The complex vulnerability index (IVC-COV2 index for its abbreviation in Spanish) was used to set the pretest probability. Likelihood ratios were integrated into a Fagan nomogram for posttest probabilities, and IVC-COV2 + National Early Warning Score (NEWS) values and CURB-65 scores were generated. Absolute and relative diagnostic gains (RDGs) were calculated based on pretest and posttest differences. RESULTS: The IVC-COV2 index was derived from a population of 1,055,746 individuals and was based on mortality in high-risk (71.97%), intermediate-risk (26.11%), and low-risk (1.91%) groups. The integration of models in which IVC-COV2 intermediate + NEWS ≥ 5 and CURB-65 > 2 led to a "number needed to (NNT) diagnose" that was slightly improved in the CURB-65 model (2 vs. 3). A comparison of diagnostic gains revealed that neither the positive likelihood ratio (P = 0.62) nor the negative likelihood ratio (P = 0.95) differed significantly between the IVC-COV2 NEWS model and the CURB-65 model. CONCLUSION: According to the proposed mathematical model, the combination of the IVC-COV2 intermediate score and NEWS or CURB-65 score yields superior results and a greater predictive value for the severity of illness. To the best of our knowledge, this is the first population-based/mathematical model developed for use in COVID-19 critical care decision-making.
ABSTRACT
Background: Diabetes mellitus has been established as a contributory factor for comorbidity in subjects with COVID-19 owing to diabetics being at high infection susceptibility from different bacteria and viruses including those of the respiratory tract. CURB 65 scores are an easier system among the various scoring systems developed to assess CAP risk. Aim: To record and comparatively analyze the CURB-65 scores in non-diabetic and diabetic subjects hospitalized for COVID-19 infection in an Indian health care center. Methods: In 280 subjects admitted for COVID-19 infection, glycemic state and CURB-65 scores were evaluated. The subjects were grouped as having mild, moderate, or severe illnesses based on the CURB-65 scoring. Also, ICU admission, the requirement of a ventilator, hospitalization duration, and mortality rates were assessed. All subjects were followed till discharge or death, whichever was early. Results: Mild CURB-65 was seen for 65.21% (n=90) diabetic subjects and 97.18% (n=138) non-diabetic subjects. 30.43% (n=42) diabetic subjects and 2.81% (n=4) non-diabetic subjects had CURB-65 scores as moderate. ICU admission was needed in 24.63% (n=34) diabetic subjects and in 5.63% (n=8) non-diabetic subjects (p=0.002). Ventilatory support was needed in 18.84% (n=26) diabetic subjects in the study and in 4.22% (n=6) non-diabetic subjects. This difference was statistically significant with p=0.007. 24.63% (n=34) diabetic subjects died and in non-diabetic (p<0.0001). The mean duration of hospital stay was 9.23±5.2 days in diabetic subjects and 7.03±4.28 days in nondiabetic subjects (p=0.005). Conclusion: Increased and higher values of CURB-65 scores were seen for subjects having diabetes mellitus and COVID-19 infection compared to non-diabetic subjects with COVID-19 infection. Also, the disease severity was more in subjects with diabetes mellitus and COVID-19 compared to non-diabetics. [ FROM AUTHOR]