Monotherapy versus polytherapy of enoxaparin and hydroxychloroquine for the treatment of COVID-19: A randomized controlled clinical trial.

Objectives: The current study aims to assess the efficacy and safety of Enoxaparin and hydroxychloroquine (HCQ) used as monothrapy or polytherapy versus standard care alone in Coronavirus 2019 (COVID-19) infected patients. Methods: The current study included two hundred patients with laboratory confirmed COVID-19 infection. Patients admitted to hospital were randomly allocated into four groups: group I: received standard COVID-19 therapy, group II: received Enoxaparin 40mg/day subcutaneously (SC) plus standard therapy, group III: received 400 mg/day HCQ plus standard therapy & group IV: received a combination of 400 mg/day HCQ and Enoxaparin plus standard COVID-19 therapy. The disease progression was evaluated by duration to a negative polymerase chain reaction (PCR), length of hospital or Intensive Care Unit (ICU) stay, and mortality rate. The safety of treatments was evaluated by measuring adverse effects. Results: The length of hospital stay, ICU admission and mortality were significantly decreased in Enoxaparin plus standard COVID-19 therapy group versus other groups. Conclusion: These findings suggest that Enoxaparin was safe, effective, and well tolerated and has a role in decreasing the progression of the disease and its complications while HCQ did not discover any evidence of extra therapeutic benefits.

Predictors of intensive care unit length of stay and mortality among unvaccinated COVID-19 patients in Jordan.

Background: Factors associated with mortality and intensive care unit (ICU) admission due to Coronavirus Disease 2019 (COVID-19) in Jordanian patients are not known particularly among unvaccinated patients. Aim: To examine predictors of mortality and ICU stay in unvaccinated COVID-19 patients in the north of Jordan. Methods: Patients admitted with COVID-19 between October-December 2020 were included. Data on baseline clinical and biochemical characteristics, length of ICU stay, COVID-19 complications and mortality were collected retrospectively. Findings: 567 COVID-19 patients were included. The mean age was 64.64±0.59 years. 59.9% of patients were males. The mortality rate was 32.3%. Underlying cardiovascular disease or diabetes mellitus was not associated with mortality. The mortality increased with the number of underlying diseases. Independent predictors of ICU stay were neutrophil/lymphocyte ratio, invasive ventilation, the development of failure, myocardial infarction, stroke and venous thromboembolism. The use of multivitamins was observed to be negatively associated with ICU stay. Independent predictors of mortality were age, underlying cancer, severe COVID-19, neutrophil/lymphocyte ratio, C-reactive protein (CRP), creatinine level, pre-use of antibiotics, ventilation during hospitalisation, and length of ICU stay. Conclusion: COVID-19 was associated with an increased length of ICU stay and mortality among unvaccinated COVID-19 patients. The prior use of antibiotics was also associated with mortality. The study highlights the need for close monitoring of respiratory and vital signs, inflammatory biomarkers such as WBC and CRP, and prompt ICU care in COVID-19 patients.

Effectiveness of different vaccine platforms in reducing mortality and length of ICU stay in severe and critical cases of COVID-19 in the Omicron variant era: A national cohort study in Iran.

Various severe acute respiratory syndrome coronavirus 2 vaccines with different platforms have been administered worldwide; however, their effectiveness in critical cases of COVID-19 has remained a concern. In this national cohort study, 24 016 intensive care unit (ICU) coronavirus disease-2019 (COVID-19) admissions were included from January to April 2022. The mortality and length of ICU stay were compared between the vaccinated and unvaccinated patients. A total of 9428 (39.25%) patients were unvaccinated, and 14 588 (60.75%) patients had received at least one dose of the vaccine. Compared with the unvaccinated, the first, second, and third doses of vaccine resulted in 8%, 20%, and 33% lower risk of ICU mortality in the adjusted model, with risk ratio (RR): 0.92, 95% confidence interval (CI): 0.84-1.001, RR: 0.80, 95% CI: 0.77-0.83, and RR: 0.67, 95% CI: 0.64-0.71, respectively. The mean survival time was significantly shorter in the unvaccinated versus the fully vaccinated patients (hazard ratio [HR]: 0.84, 95% CI: 0.80-0.88); p < 0.001). All vaccine platforms successfully decreased the hazard of ICU death compared with the unvaccinated group. The duration of ICU stay was significantly shorter in the fully vaccinated than in unvaccinated group (MD, -0.62, 95% CI: -0.82 to -0.42; p < 0.001). Since COVID-19 vaccination in all doses and platforms has been able to reduce the risk of mortality and length of ICU-stay, universal vaccination is recommended based on vaccine availability.

Chest CT severity score as a predictor of mortality and short-term prognosis in COVID-19.

Background: As India was slowly coming out of shock from the second wave wrecked by the Delta strain, the world population is now struck once again with a new strain of coronavirus disease 2019 (COVID-19), designated as B.1.1.529, named as OMICRON. Though several international studies have evaluated the role of computed tomography (CT) in diagnosis, predicting prognosis, and monitoring the progression of disease, to our best knowledge, there are no Indian studies published in this context. Objective: (1) To determine the use of chest CT severity score as predictor of mortality in COVID-19 patients. (2) To determine the prognosis based on length of hospital stay. Materials and Methods: A observational cohort study was done at Travancore Medical College Hospital. A retrospective analysis of patients who presented to the Emergency Medicine Department with a positive COVID antigen or reverse transcriptase-polymerase chain reaction (RT-PCR) results and those who underwent a CT chest at the time of presentation was conducted. Data was analyzed by using Statistical Package for Social Sciences (SPSS) version 16. Descriptive statistics such as mean, frequency, and percentages were calculated. Chi-square test was used to find the statistical significance. The Kaplan-Meier method was used to evaluate the relationship between CT score and mortality, which was compared with the log-rank test. Results: A total of 252 patients with positive COVID antigen or RT-PCR who underwent CT chest were included in our study. Our study population was composed of 139 (55.2%) males and 113 (44.8%) females. Only one patient with mild CT severity score required >14 days of ICU stay, whereas two (2%) and five (9.6%) patients with moderate and severe CT severity score, respectively, required ICU stay for >14 days. The P value was 0.001, which again is statistically significant. In our study, out of 44 patients categorized under mild CT severity score, only two (4.5%) patients had expired. Out of 98 patients categorized under moderate CT severity score, 14 (14.3%) patients had expired, whereas out of 52 patients categorized under severe CT severity score at the time of admission, 25 (48.1%) patients had expired. The P value was 0.001, which is statistically significant. Conclusion: Our study could prove that patients with CT severity score ≥15 had high risk of mortality and required prolonged ICU stay of >5 days. CT severity score helps the primary care physicians to predict probable outcome and length of hospital stay at the time of admission itself and allocate the limited resources appropriately.

Chronic Critical Illness in Patients with COVID-19: Characteristics and Outcome of Prolonged Intensive Care Therapy.

The spread of SARS-CoV-2 caused a worldwide healthcare threat. High critical care admission rates related to Coronavirus Disease 2019 (COVID-19) respiratory failure were observed. Medical advances helped increase the number of patients surviving the acute critical illness. However, some patients require prolonged critical care. Data on the outcome of patients with a chronic critical illness (CCI) are scarce. Single-center retrospective study including all adult critically ill patients with confirmed COVID-19 treated at the Department of Intensive Care Medicine at the University Medical Center Hamburg-Eppendorf, Germany, between 1 March 2020 and 8 August 2021. We identified 304 critically ill patients with COVID-19 during the study period. Of those, 55% (n = 167) had an ICU stay ≥21 days and were defined as chronic critical illness, and 45% (n = 137) had an ICU stay <21 days. Age, sex and BMI were distributed equally between both groups. Patients with CCI had a higher median SAPS II (CCI: 39.5 vs. no-CCI: 38 points, p = 0.140) and SOFA score (10 vs. 6, p < 0.001) on admission. Seventy-three per cent (n = 223) of patients required invasive mechanical ventilation (MV) (86% vs. 58%; p < 0.001). The median duration of MV was 30 (17-49) days and 7 (4-12) days in patients with and without CCI, respectively (p < 0.001). The regression analysis identified ARDS (OR 3.238, 95% CI 1.827-5.740, p < 0.001) and referral from another ICU (OR 2.097, 95% CI 1.203-3.654, p = 0.009) as factors significantly associated with new-onset of CCI. Overall, we observed an ICU mortality of 38% (n = 115) in the study cohort. In patients with CCI we observed an ICU mortality of 28% (n = 46) compared to 50% (n = 69) in patients without CCI (p < 0.001). The 90-day mortality was 28% (n = 46) compared to 50% (n = 70), respectively (p < 0.001). More than half of critically ill patients with COVID-19 suffer from CCI. Short and long-term survival rates in patients with CCI were high compared to patients without CCI, and prolonged therapy should not be withheld when resources permit prolonged therapy.

Outcomes and Timing of Bedside Percutaneous Tracheostomy of COVID-19 Patients over a Year in the Intensive Care Unit.

BACKGROUND: The benefits and timing of percutaneous dilatational tracheostomy (PDT) in Intensive Care Unit (ICU) COVID-19 patients are still controversial. PDT is considered a high-risk procedure for the transmission of SARS-CoV-2 to healthcare workers (HCWs). The present study analyzed the optimal timing of PDT, the clinical outcomes of patients undergoing PDT, and the safety of HCWs performing PDT. METHODS: Of the 133 COVID-19 patients who underwent PDT in our ICU from 1 April 2020 to 31 March 2021, 13 patients were excluded, and 120 patients were enrolled. A trained medical team was dedicated to the PDT procedure. Demographic, clinical history, and outcome data were collected. Patients who underwent PDT were stratified into two groups: an early group (PDT ≤ 12 days after orotracheal intubation (OTI) and a late group (>12 days after OTI). An HCW surveillance program was also performed. RESULTS: The early group included 61 patients and the late group included 59 patients. The early group patients had a shorter ICU length of stay and fewer days of mechanical ventilation than the late group (p < 0.001). On day 7 after tracheostomy, early group patients required fewer intravenous anesthetic drugs and experienced an improvement of the ventilation parameters PaO2/FiO2 ratio, PEEP, and FiO2 (p < 0.001). No difference in the case fatality ratio between the two groups was observed. No SARS-CoV-2 infections were reported in the HCWs performing the PDTs. CONCLUSIONS: PDT was safe and effective for COVID-19 patients since it improved respiratory support parameters, reduced ICU length of stay and duration of mechanical ventilation, and optimized the weaning process. The procedure was safe for all HCWs involved in the dedicated medical team. The development of standardized early PDT protocols should be implemented, and PDT could be considered a first-line approach in ICU COVID-19 patients requiring prolonged mechanical ventilation.

Impact of COVID -19 in cancer patients on severity of disease and fatal outcomes: A systematic review and meta-analysis.

BACKGROUND AND AIMSBACKGROUND: Currently there is limited knowledge on cancer and COVID-19; we conducted a systematic review and meta-analysis to evaluate the impact of cancer on serious events including ICU admission rate and mortality in COVID 19. METHODS: PubMed, Cochrane Central Register of Clinical Trials were searched on April 16, 2020, to extract published articles that reported the outcomes of cancer in COVID-19 patients. The search terms were "coronavirus" and "clinical characteristics" with no language or time restrictions. We identified 512 published results and 13 studies were included in the analysis. RESULTS: There were 3775 patients, of whom 63 (1·66%) had a cancer. The pooled estimates of ICU admission in COVID 19 patients with and without cancer were 40% versus 8·42%.The odds ratio of ICU admission rates between the cancer and non-cancer groups was 2.88 with a 95% CI of 1·18 to 7·01 (p = 0·026). The pooled estimates of death rate in COVID -19 patients with and without cancer were 20·83% versus 7·82%. The odds ratio of death rates between the cancer and non-cancer groups was 2.25 with a 95% CI ranging from 0·71 to 7·10 with p value of 0·166. The pooled prevalence of cancer patients was 2% (95 CI 1-4). CONCLUSIONS: Presence of cancer in COVID-19 leads to higher risk of developing serious events i.e. ICU admission, mechanical ventilation and mortality. The presence of cancer has a significant impact on mortality rate in COVID-19 patients.