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OBJECTIVE: Wide arrays of laboratory parameters have been proposed by many studies for prognosis in COVID-19 patients. In this study, we wanted to determine if the International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score in addition to certain clinical and laboratory parameters would help in predicting mortality. We wanted to determine if a greater severity score on chest x-ray at presentation translated to poor patient outcomes using the COVID-19 chest radiography score. MATERIAL AND METHODS: This retrospective study was conducted at SDS TRC and Rajiv Gandhi Institute of chest diseases, Bangalore from March 2021 to June 2021. This study included 202 real-time-polymerase chain reaction-positive COVID-19 patients aged above 18 years admitted to the intensive care unit of our hospital. Demographic characteristics and baseline hematological and inflammatory markers (serum C-reactive protein, lactate dehydrogenase, troponin-I, ferritin, and d-dimer) were collected. Radiological severity on a chest x-ray was assessed using the validated COVID-19 chest radiography score. The International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score was assigned to each patient within 24 hours of intensive care unit admission. Outcome studied was in-hospital mortality. RESULT(S): The overall mortality was 54.9% (111 cases). Age more than 50 years, >4 days of symptoms, peripheral oxygen saturation/ fraction of inspired oxygen ratio less than 200, elevated serum lactate dehydrogenase >398.5 IU/L, and hypoalbuminemia (<2.95 g/dL) were detected as independent predictors of mortality. A significant correlation of risk stratification with mortality (P = .057) was seen with International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score. There was no significant correlation between the COVID-19 chest radiography score and mortality. CONCLUSION(S): Age >50 years, peripheral oxygen saturation/fraction of inspired oxygen ratio <200, mean symptom duration of >4 days, elevated serum lactate dehydrogenase, and hypoalbuminemia are independent predictors of mortality in severe COVID-19 pneumonia. International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score was different in the survivors and deceased.Copyright © Author(s).
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Objective: To evaluate an association between severity of COVID19 infection in hospitalized patients belonging to different ethnic backgrounds with various demographic data across two waves of the pandemic. Method(s):728 COVID19 patients admitted between April 2020 and March 2021 were retrospectively analysed. Result(s):295 patients(40.5%)were from ethnic minority groups(EMG). Severe COVID19 based on chest Xray scores were not significantly different among EMGs and whites. Intensive therapy unit(ITU)admissions was required in 12% of white patients compared to 20% of EMGs(p=0.001). Continuous positive airway pressure(CPAP)was required in 22% vs 24%(p=0.12)and mechanical ventilation in 5% vs 10%(p=0.013)of whites and EMG patients,respectively. Mortality was significantly higher in White as compared to EMG(11% vs 6%;p=0.001). When the outcomes were compared between two waves(April-August 2020 and September 2020-March 2021)of COVID19,a significantly higher number of EMGs required CPAP support during first wave(5.3%vs2.6%;p=0.008)compared to second wave,where the difference was not significant(11.6%vs15.5%;p=0.465). Mortality was higher in whites as compared to EMGs during second wave(5.7%vs1.7%:p=0.03). Conclusion(s): Although mechanical ventilation and ITU admission was higher among EMGs,the overall mortality was more in whites.
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Purpose: The relationship between thyroid metabolism and coronavirus disease 2019 (COVID-19) inflammation has been extensively investigated. This meta-analysis aimed to evaluate the prognostic properties of unspecified thyroid disorders, hypothyroidism and hyperthyroidism for predicting poor COVID-19 outcomes. Method(s): We conducted systematic literature searching through multiple databases-PubMed, EBSCO and CENTRAL up until 27 September 2021. The main exposure was unspecified thyroid disorders, hypothyroidism or hypothyroidism on-admission status. The outcome of interest was the COVID-19 composite poor outcome that comprises severity, mortality, ICU admission and hospitalisation. Result(s): There were 24517 patients from 20 studies. Meta-analysis showed that thyroid disorder, regardless of its type, was associated with COVID-19 poor outcome (OR 2.92 (95% CI 2.09 - 4.08), P < 0.001;I 2 = 71%, P < 0.001). Unspecified thyroid disorder has a sensitivity of 0.17 (0.08-0.33), specificity of 0.94 (0.88-0.97) and Area Under Curve (AUC) of 0.66. Hypothyroidism has a sensitivity of 0.24 (0.12-0.42), specificity of 0.92 (0.87-0.96) and AUC of 0.77. Hyperthyroidism has a sensitivity of 0.05 (0.02-0.11), specificity of 0.98 (0.88-1.00) and AUC of 0.36. In this pooled analysis, the posttest probability of unspecified thyroid disease, hypothyroidism and hyperthyroidism were 42%, 27% and 8% for poor outcomes, respectively. Conclusion(s): Thyroid disorders are associated with poor COVID-19 prognosis.Copyright © 2022 Authors. All rights reserved.
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Introduction: COVID-19 is a droplet-transmitted infection with clinical manifestation ranging from mild disease to cytokine storm. The cytokine storm is an exaggerated response of the human body in which excessive amounts of inflammatory markers are released leading to multiple organ failure. In COVID-19, the most common electrolyte disorder noted is hyponatremia. Hyponatremia results from an increase in cytokines including IL-6 can result in the release of anti-diuretic hormone causing a decrease in serum sodium. Hyponatremic patients were observed to have increased risk for ICU admission, mechanical ventilation and mortality as compared to normonatremia. The inflammatory markers including serum ferritin, procalcitonin, IL-6, HsCRP, LDH, and D-dimer have been imperative as prognostic markers to help guide healthcare workers in the classification of severity, thereby guiding management. This study aims to investigate the association between serum sodium and serum IL-6 and aims to establish the role of serum sodium as an alternative cost-effective prognostic marker for COVID-19. Method(s): This is a retrospective cohort study done at the University of Santo Tomas Hospital via chart review of all confirmed COVID-19 patients admitted from January to August 2021. Data gathered included patient's age, gender, pertinent co-morbidities, day of illness on arrival, serum Na, PF ratio, chest radiograph, IL-6 levels on admission. The outcome of each case was recorded: oxygen supplementation, need for hemoperfusion, need for tocilizumab, COVID classification, days until clinical recovery, discharged, or expired. Corrected serum was used to account for effect of serum glucose on serum sodium. Serum sodium and IL-6 levels were compared to check the relationship between the two. Hyponatremia was studied in line with the poor outcomes. COVID-19 patients admitted at the COVID ward of USTH, January to August 2021 was the target population of the study. Those excluded were patients with chronic kidney disease patients, chronic hyponatremia, malignancy, uncontrolled thyroid disease, liver cirrhosis, on diuretics, with gastrointestinal losses and incomplete records. [Formula presented] Results: Of the 322 admitted COVID-19 patients, 154 were included with 89 (58%) having poor outcomes. Hyponatremia was seen in 60 (38.9%) of the population while 48 (53.93%) had poor outcomes. Serum sodium and IL-6 have an inverse relationship is not statistically significant. Patients with hyponatremia were 4.46 times more likely to require high oxygen support, 4.16 times more likely to need hemoperfusion, and 60.71% times more likely to have ICU admission. Hyponatremia was shown to have a 94.12% likelihood need for tocilizumab, 3.87 times more likely to result in severe or critical COVID-19 and 3.78 times more likely to expire. Overall, hyponatremia was 5.17 times more likely to have poor clinical outcome in comparison to normonatremia. Conclusion(s): Serum sodium cannot replace serum IL-6 as an inflammatory marker, but could be considered as a potential prognostic marker for COVID-19 when inflammatory markers are not available. COVID-19 patients with hyponatremia have a higher predisposition to increased disease severity. Including serum sodium in scoring systems could help signal to the health care providers that a more aggressive treatment approach would be indicated, thus aiding physicians in managing patients more effectively. No conflict of interestCopyright © 2023
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Introduction: Acute Kidney Injury is common among COVID-19 patients and is associated with adverse outcomes. This study aims to determine AKI's prevalence and short-term outcomes among admitted COVID-19 patients, as this is not well understood in East Africa. Method(s): We reviewed medical records of all laboratory confirmed COVID-19 patients hospitalized in a private facility in Nairobi between 1st January and 31st December 2021. Data on patient baseline characteristics, clinical course during admission and short-term outcomes were extracted. Patients with confirmed renal failure at admission, chronic dialysis before admission or patients with less than 2 serum creatinine levels measurements available were excluded. AKI was defined according to the KDIGO criteria using serum creatinine levels. Descriptive statistics of means, medians, inter-quartile range and standard deviation as well as the use of frequency/proportion/percentages for categorical variables were used for profiling participants' socio-demographics and clinical parameters. Means for patients with AKI and those without AKI were compared using the Mann-Whitney U test and the Kruskal-Wallis test for continuous variables, Chi-square test was used for categorical variables. Univariate and logistical regression analysis was used to determine the association between AKI severity and various risk factors. Result(s): The majority of the 365 included patients were male (61.4%) aged >= 50 years. AKI developed in 74 (20.3%) patients with 52.7%, 18.9% and 28.4% in stages 1, 2 and 3 respectively. Of these 13.5% needed renal replacement therapy. AKI was common in critically ill patients (43.2%) with the majority being in stages 2 and 3. It was further associated with respiratory failure as 36.0% of mechanically ventilated patients developed AKI compared to 17.8% of non-ventilated patients. Among the AKI patients, 24.3% died and 75.7% were discharged. Of the survivors, the majority (56.8%) achieved full renal recovery at discharge. The AKI risk factors were older age (OR 1.046 p<0.001), male sex (OR 2.490 p 0.002), multiple comorbidities (OR 3.694 p 0.001), hypertension (OR 2.598 p 0.001), diabetes mellitus (OR 2.586 p<0.001) and pre-existing CKD (OR 10.550 p<0.001). Conclusion(s): AKI in COVID-19 is common and results in full renal recovery in most patients. Its severity increases in critically ill patients and is significantly associated with respiratory failure and mortality. No conflict of interestCopyright © 2023
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Introduction: Dysnatremia is common in patients with acute coronavirus disease 2019 (COVID-19). Robust studies looking at the association between sodium imbalance in patients with COVID-19 and clinical outcome remain lacking.This study aimed to identify the prevalence of dysnatremia among patients hospitalized with acute COVID-19 infection. It also sought to determine the association between serum sodium and both mortality and morbidity, as measured by the severity of COVID-19 infection, the need for ventilatory support, intensive care unit (ICU) admission and acute kidney injury (AKI). We sought to evaluate whether sodium levels, a relatively inexpensive and easily accessible lab investigation, may be employed as a predictor of outcome in patients admitted with COVID-19 infection. Method(s): This was a retrospective cohort studyconducted from an electronic medical records review of all hospitalized, adult patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) at the University Hospital of the West Indies between August 1, 2020, and January 31, 2021. The relationship between dysnatremia (serum sodium <135 mmol/l or >145 mmol/l) and in-hospital mortality and morbidity were examined. A total of 374 COVID-19 patients were enrolled. The study was approved by the Mona Campus Research Ethics Committee, an independent body which is housed in the Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica. Result(s): The incidence of hyponatremia and hypernatremia were 29.4% and 6.1% respectively. The mean admission serum sodium was 137.3 +/- 6.0 mmol/l. At the end of the study period, the prevalence of hyponatremia and hypernatremia was 50.3% and 19.8% respectively. Acute kidney injury occurred in 117 patients (31.3%) with 23 patients (6.1%) having an unknown status due to missing data. Hypernatremia was associated with a higher prevalence of AKI (60.9%) than hyponatremia (35.5%) (chi2=13.8, p=0.008). Serum sodium at presentation was higher among the non-survivors (139.3 +/- 7.2 mmol/l), compared to the survivors (136.7 +/- 5.5 mmol/l) (p<0.001). Patients with hypernatremia had a survival rate of 52.2% at a survival average of 18.3 days, significantly lower than patients with hyponatremia (80.9%) or normonatremia (77.6%) (p=0.001). There was statistically significant association between the presence of hypernatremia and in-patient mortality (chi2=9.0, p=0.011) but there was no association with hyponatremia. The majority of the patients (56.1%) had severe COVID-19 infection. Non-severe and critically ill patients accounted for 32.1% and 11.8% respectively.Comparison of serum sodium at presentation to the severity of COVID-19 infection did not show statistical significance(chi2=1.7, p=0.794). There was no statistically significant difference between serum sodium levels and oxygen therapy (chi2=1.4, p=0.502) or the use of mechanical ventilatory support (chi2=4.6, p=0.798). There was no statistical significance in the length of hospital stay across sodium groups (p=0.179). Conclusion(s): Hypernatremia was associated with both a higher risk of acute kidney injury and in-hospital mortality, but not morbidity. Hyponatremia either on admission or developed during the hospitalization was not associated with poor clinical outcomes. Serum sodium can be used in the prognostication and risk stratification of patients with acute COVID-19 infection. No conflict of interestCopyright © 2023
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Introduction: Coronavirus Disease 2019 (COVID-19) rapidly became a global pandemic since its emergence in China in December 2019, affecting more than 4.5 million people since then. Patients with Chronic Kidney Disease on dialysis are said to be susceptible to COVID-19 infection. Data published on COVID-19 among this vulnerable group are limited, hence this study aimed to determine the clinico- demographic characteristics of patients on maintenance dialysis with COVID-19 infection and its association to clinical outcomes in a tertiary hospital in Baguio City, Philippines. Method(s): This is a cross-sectional study with a retrospective design utilizing chart review of 165 of 203 dialysis patients admitted at Baguio General Hospital and Medical Center (BGHMC) for COVID-19 infection from March 01, 2020 to December 31, 2021. The clinico- demographic characteristics were described and it determined the association of these to clinical outcomes. Both descriptive and inferential statistics were used in this study. Result(s): The mean age was 53.48 years old with male predominance. About 97% were on hemodialysis, whereas 2.5% were on peritoneal dialysis. Dialysis vintage mean was 3.19 years. Hypertension, diabetes mellitus and coronary artery disease were the most common comorbidities. Majority of them had severe COVID-19 (69%). Diabetes Mellitus as a comorbidity and COVID-19 severity status were associated with mortality, ICU admission and use of mechanical ventilation. Presence of outliers in length of hospital stay based on COVID-19 severity status and ICU admission was also observed. Conclusion(s): Diabetes Mellitus and COVID-19 severity status were associated with poor outcomes. Therefore, special attention should be given to this group emphasizing the importance of taking appropriate precautions in order to avoid getting infected with Covid-19. Achievement of good glycemic control should be emphasized. Longer data collection period could also allow future researchers investigate the impact of various treatment schemes and vaccination status on clinical outcomes. No conflict of interestCopyright © 2023
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Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic placed an enormous strain on the healthcare system. Data on the impact of COVID-19 on the utilization and outcomes of structural heart disease (SHD) interventions in the United States are scarce. Method(s): The National Inpatient Sample from 2016 to 2020 was queried to identify adult admissions for transcatheter aortic valve replacement (TAVR), left atrial appendage occlusion (LAAO), and transcatheter end-to-end repair (TEER). The primary outcome was temporal trends of procedure utilization rate per 100,000 admissions over quarters from 2016 to 2020. The secondary outcomes were adjusted rates of in-hospital mortality, major complications, and length of stay (LOS). Result(s): Among 434,630 weighted admissions (TAVR: 305,550;LAAO: 89,300;TEER: 40,160), 95,010 admissions (22%) were during the COVID-19 era. There was a decline during the second quarter of 2020 followed by an increase to the pre pandemic levels (TAVR: 220 to 253, LAAO: 57 to 109, and TEER:31 to 36 per 100,000 admissions, Ptrend<0.001) (Figure). There were no differences in the mortality or major complication rates. Median LOS has decreased in TAVR (4 days to 1 day) and in TEER (3 days to 1 day) but remained stable in LAAO (1 day). Conclusion(s): This nationwide analysis showed that SHD interventions decreased during the early waves of COVID-19 pandemic. There was a significant reduction in hospital LOS without differences in in-hospital mortality or complication rates during the pandemic. These data suggest that hospitals adapted to the unprecedent challenges during the pandemic to provide advanced cardiac care to patients. [Formula presented]Copyright © 2023
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The 2022 Mary MacKinnon lecture reminds us of some of the history of the development of out of hospital specialist diabetes services in the United Kingdom. There have been multiple clarion calls across the years to collaborate, share information and values and break down traditional boundaries in the pursuit of improved patient care and outcomes. Along with this, we note the roles of clinical and managerial leadership, followership and partnership in working together with people living with diabetes to co-produce a model of diabetes care and then to ensure through good stewardship of shared resources that the expectations of that change are delivered for our population. We go on to discuss how the Diabetes Care for You team has continued to innovate and provide care during the pandemic and conclude with a vision of the future and a challenge for decision makers to put the needs of the population at the forefront of future planning. Copyright © 2023 John Wiley & Sons.Copyright © 2023 John Wiley & Sons, Ltd.
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Background: Diabetes Mellitus (DM) and hyperglycaemia (HG) have been identified as risk factors for morbidity and mortality in coronavirus disease 19 (COVID-19) infection. However, a detailed study of various categories of HG and the impacts and characteristics of each of these on COVID-19 was considered important to address this metabolic disorder in COVID-19. Aim(s): This study aimed to describe the patterns of HG and its impact on the clinical outcomes in hospitalised patients with COVID-19 infection. Methodology: Data on 1000 consecutive patients with COVID-19 were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software (SPSS Inc., Chicago, IL, USA). Result(s): A total of 1000 patients were included for analysis The overall mean age of the study group was 52.77 + 19.71 with 636 (63.6%) male patients;261 had mild, 317 moderate, and 422 severe infections;and 601 had HG (New-onset DM 66, known DM 386, steroid-induced HG 133 and stress HG 16). The HG group has significantly higher levels of inflammatory markers and worse outcomes. Blood glucose levels were higher in patients with known DM. The ROC cut-off of total steroids to predict mortality in the HG group was 84 mg versus 60 mg in the normoglycaemia group. The ROC cut-off of FBS to predict mortality in the overall HG group was 165, with AUC 0.58 (95% CI 0.52, 0.63, P = 0.005), whereas that for pre-existing DM and steroid HG were 232 and 166, which were also significant. There was a wide variation in mean glucose levels against time. Conclusion(s): HG is an independent predictor of mortality, with the highest significance in the steroid-induced category. COVID-19 morbidity and mortality can be minimised by identifying the blood glucose range for best results and instituting appropriate treatment guidelines.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Introduction: Numerous studies have shown both hyponatremia and hypernatremia to be independently associated with mortality. Patients infected with Covid-19 infection can develop severe life threatening pneumonia and the mortality in these patients can be as high as 20.3% to 27.9%. While respiratory tract involvement is one of the main manifestation of Covid -19 infection, many patients also have associated dysnatremias. The reported prevalence of hyponatremia and hypernatremia in Covid -19 patients has been 25%-45% and 3% to 7% respectively. Recently, it has also been observed that patients with covid-19 infection develop severe treatment resistant hypernatremia > 150 mEq/L, which is difficult to correct. In patients with Covid-19 infection, dysnatremia is a frequent occurrence, although its relationship with mortality needs to be established. We aimed to study the frequency of dysnatremia in patients with Covid -19 infection at different stages of admission. Method(s): This retrospective analysis was conducted at Aga Khan University Hospital, Karachi, Pakistan over a period of twelve weeks. All admitted adult patients with covid -19 were included. Three levels of serum sodium were recorded: on admission, maximum level anytime during hospital stay and at the time of discharge or death (+/- 48 hours). Based on the serum level of sodium, three definitions were used: hyponatremia, hypernatremia and normonatremia. Hypernatremia was further categorized into mild, moderate and severe. Patients developing acute kidney injury (AKI) was also recorded. The main outcome measure was inpatient mortality. Result(s): The study included 574 patients;median age was 55.6 +/-14.4 years. On admission, the mean sodium was 135.9 +/- 6.4 mEq/L, 39% patients had hyponatremia and 4.7% had hypernatremia. During hospital admission, the percentage of hypernatremia increased to 18.8%: 12.7% had mild, 4.5% had moderate and 1.6% had severe hypernatremia. The mean serum sodium, during hospital stay, in patients who survived was around 140.6 +/- 5 as compared to 151 +/- 9.9 mEq/L in those who died with p value <0.001. The last mean serum sodium checked before death or discharge (+/- 48 hours) was 145.4 +/- 9.4 mEq/L as opposed to 137.7 +/- 3.7 mEq/L with p value of <0.001 in patients who died and survived respectively. The mean serum creatinine on admission was 1.3 +/-1.3 mg/dl;200 (34.8%) patients developed AKI;100 (50%) patients developed stage 1 AKI, 49 (24.5%) had stage 2 and 50 (25%) had stage 3 AKI. Around 36 (6.3%) required renal replacement therapy. The predictors of AKI included severity of Covid-19 [p = 0.001], age [p = <0.001], hypertension [p = 0.04] and invasive ventilation [p = 0.01]. Overall, mortality was 10.97%. Conclusion(s): Hyponatremia on admission is commonly seen in patients admitted with Covid -19 infection, whereas hypernatremia is a frequent finding in patients who could not survive, however their association with mortality needs to be established. No conflict of interestCopyright © 2023
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Introduction: Since the discovery of SARS COV2 in 2019, several biological markers were reported as poor prognostic factors. Aim(s): Evaluate the value of eosinophil count (EC) on admission as a predictive marker of unfavorable outcomes. Patient and method: A retrospective study was conducted from January to July 2021, including 400 patients in the Covid department of Gabes university hospital. We compared the clinical data, lab findings, including inflammatory markers, radiological findings, course and severity (mortality, ICU admission, and need for mechanical ventilation) in 2 groups: patients with eosinophilia (G1 (n=57 cases)) to those without eosinophilia (G2 (n=343 cases)). Result(s): The median age was 67,7 years in G1 and 63,7 years in G2. The female sex was predominant in the G1 (52,6% of cases), while in the G2 the dominant sex was male (52,2%). The most common comorbidities in both groups were: diabetes (52,6% in G1 vs 29,7% in G2), hypertension (17,5% in G1 vs 40,2% in G2) and heart diseases (28% in G1 vs 13% in G2). Patients with eosinophilia had a higher CRP than G 2 (138 mg/dl vs 122 mg/dl). Severe and critical CT damage was important in G1 than G2 (49,1% vs 38,2% patients ;p=0,16). They also had a higher ICU admission and mortality (38,6% in G1 vs 27,4% in G2 ;p=0,08, 66,7% vs 37,3% ;p=3.10-6 respectively). The duration of ICU admission in G1 was shorter than G2 (the average hospitalization duration was 3,8 days in G1 vs 4,23 days in G2). G1 had higher mechanical ventilation (45,6%) than G1 (23,3%) (p=4.10-5). Conclusion(s): The eosinophil's count must be evaluated at the admission of the patients to know the prognosis and to improve the management.
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Background: Cancer patients have increased risk for severe outcomes related to SARS-CoV-2 infection (COVID-19), due to their increased vulnerability to infection, older age, and comorbidities in comparison to the general population. While multiple studies have been completed examining outcomes of COVID-19 infection in cancer patients overall, there has been limited investigation into the outcomes of COVID-19 infection in patients with genitourinary (GU) cancers. Method(s): We completed a single institution retrospective study to examine the outcomes of adults with GU cancers and COVID-19 infection from March 10, 2020 to June 15, 2022. Baseline data included age, sex, BMI, type of malignancy, cancer status (stable or progressive disease, in remission), current and previous anticancer therapy received, and comorbidities. Result(s): Eighty-four patients with a GU cancer diagnosis and laboratory-confirmed SARS-CoV-2 infection were identified. Seventy-nine (94%) were male and the median age was 64 years (range 24-91). Forty-four (52%) were non-Hispanic white, 28 (33%) were Hispanic, and 11 (13%) were African-American. Prostate cancer was the most common (n = 45), followed by renal cell carcinoma (n = 20), testicular (n = 9), bladder (n = 6), and penile cancer (n = 3). Eight patients had >=2 episodes of COVID-19 infection. Sixty-three percent of patients were unvaccinated at the time of infection, while 37% of patients had breakthrough infection. Hospitalization was required for 39.3% (n = 33), with 4.8% (n = 4) requiring ICU admission. Of the patients requiring hospitalization, 26.2% (n = 22) died. Hospitalization was associated with having>=2 comorbidities (OR 18.6 [95% CI, 3.1-111.8], p<0.01) and receiving active cancer treatment (OR 12.4 [95% CI, 1.92- 79.7], p, 0.01). Mortality was associated with advanced age (OR 21.7 [95% CI, 1.40-341.7], p=0.03) and >=2 comorbidities (OR 19.2 [95% CI, 3.02-122.5], p=0.02). Vaccination was negatively associated with both hospitalization (OR 0.04 [95% CI, 0.02-0.91], p=0.04) and mortality (OR 0.14 [95% CI, 0.02-0.84], p=0.03). Conclusion(s): Among patients with GU cancer, advanced age and comorbidities are associated with adverse outcomes of COVID-19 infection;vaccination is protective. With the emergence of variants and waning immunity of vaccines, our findings highlight the importance of development and implementation of enhanced mitigation strategies in cancer patients, especially those undergoing active cancer treatment.
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Introduction: Covid-19 pneumonia presents with high morbidity and mortality and predictive biomarkers to guide treatment plans are lacking. Aim(s): To investigate the role of interleukin 6 (IL-6) on admission as a predictor for severe disease in patients admitted to a tertiary respiratory centre. Material(s) and Method(s): Retrospective study of patients admitted to our Department due to COVID19 pneumonia between 09.2021-12.2021. Medical records and local registry were thoroughly reviewed. Result(s): 149 patients were retrospectively reviewed with a mean age 64.5 years, (56% female, 44% male). IL-6 levels were not associated with the length of stay on the ward (p>0.5) or in the intensive care unit (p=0.5) or the patients' vaccination status. IL6<15 was associated with respiratory sufficiency and increased IL6 levels (>75) were associated with an increased risk for intubation and mechanical ventilation although not statistically significant. IL-6 levels on admission were not associated with pO2/FiO2 ratio or 28day mortality. Conclusion(s): In our cohort of patients IL-6 was not a predictive biomarker for clinical outcomes and therefore would not be a tangible tool to guide treatment plans.
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Introduction: Severe COVID-19 can result in rapid clinical deterioration consistent with cytokine release syndrome leading to mechanical ventilation. Aim(s): To evaluate clinical outcomes in patients with severe COVID-19 pneumonia who were treated with Tocilizumab in an attempt to hinder their downfall to mechanical ventilation. Material(s) and Method(s): We reviewed consecutive inpatients with severe pneumonia secondary to COVID-19 confirmed by nasopharyngeal polymerase chain reaction (PCR) between March 2021 and December 2021 who presented with >50% lung infiltrates on chect CT scan, WHO score 6-8, pO2/FiO2<200. Result(s): 135 patients received Tocilizumab compared to 160 controls who received standard care. Baseline demographics, comorbidities, inflammatory markers, and corticosteroid treatment were similar between the two groups. Patients who received Tocilizumab had significantly lower intubation rates (6% vs 19%, P = 0.001) than controls and lower 60day mortality (3% versus 8.9%, p=0.02). Age range was similar in the Tocilizumab and control group. Importantly, there were no secondary infections observed in the Tocilizumab group. Conclusion(s): Administration of tocilizumab in carefully selected patients with severe COVID19 pneumonia hindered their downfall to intubation, decreased 60day mortality and improved clinical outcomes.
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Background: Concerns regarding the availability of Positive Pressure Ventilation (PPV) have led the quest for alternative methods of oxygenation. One such method is Dual Oxygenation - the addition of a reservoir mask (RM) on top of a high flow nasal cannula (HFNC). Thus far, this method has not been formally evaluated. Method(s): The registry of all patients hospitalized between 1/1/2020-31/8/2021, in any one of six dedicated COVID19 wards of our tertiary hospital were reviewed. Inclusion required: 1) severe hypoxemia requiring the use of HFNC and 2) 18 years of age or older. Exclusion criteria were: 1) PPV (either noninvasive or invasive) initiated for any reason other than refractory hypoxemia (e.g. surgery) or 2) transfer to another facility while still on HFNC. The primary outcome was mortality within 30 days from the first application of HFNC. Secondary outcomes were the initiation of invasive intermittent positive pressure ventilation (IPPV) and admission to an ICU. Result(s): A total of 461 patients were included in the final analysis: 219 were treated with the combination of HFNC and RM (dual oxygenation) and 242 with HFNC alone (controls). No significant differences in the incidence of chronic diseases, smoking status or body mass index and markers of disease severity at presentation were noted between the groups. Mortality within 30 days of HFNC initiation (23.7% vs. 32.4%, Pv=0.048), rates of IPPV (49.3% vs. 58.7%, Pv=0.043) and ICU admissions (42.4% vs. 52.1%, Pv=0.039) were all significantly lower in the dual oxygenation group. Conclusion(s): Our study suggests that dual oxygenation may improve the short term prognosis of patients hospitalized with COVID-19 associated hypoxemic respiratory failure.
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Background: Recently emerged COVID-19 pandemic has caused a large number of deaths with lacs of confirmed cases worldwide posturing a grim situation and severe threat to public health. There is an imperative necessity of analyzing emerging clinical and laboratory data of COVID-19 pa-tients, which may contribute to elucidate the pathogenic mechanism and development of effective prevention and treatment countermeasures. Method(s): Under this article, the emerging role of High-Density Lipoprotein (HDL) was analyzed by collecting recently published articles related to this field having clinical data of COVID-19 patients. Result(s): Based on the recently published reports of laboratory-confirmed COVID-19 infected hospitalized patients it was consistently observed that levels of HDL were low at the time of admission to hospi-tal and remained relatively low during the disease course i.e., treatment, recovery, and discharge stage. It was also reported critically that levels of HDL in the patients, those did not survive, decreased continu-ously until death. Conclusion(s): These clinical reports of patients have risen the concern about probable infection and worsen the clinical outcome of a healthy person having a compromised level of HDL for COVID-19 infection. Eventually, these findings stated that there is a strong association of low HDL levels with a higher risk of COVID-19 infection and further severity of the illness. Proper attention is needed to understand the significance of altered quantity and quality of HDL in COVID-19 patients compared to healthy controls, so that appropriate therapies could be given at the right time to combat severity and mortality due to this infection.Copyright © 2021 Bentham Science Publishers.
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Introduction: High Flow Nasal Cannula (HFNC) enabled us to treat Acute Respiratory Distress Syndrome (ARDS) successfully on subsets of patients with COVID 19 without requiring invasive ventilatory support and with low mortality. Cautious use of HFNC is required to closely monitor the response in those patients with ARDS who develop clinical signs of respiratory failure. Objective(s): This study investigated the initial shunt fraction as a parameter to determine if HFNC will benefit a specific group of patients to predict who will benefit from HFNC, prevent delayed intubations and consequently conserve resources. Method(s): This was a retrospective, cohort study. Total of 205 Covid19 critical patients initially on HFNC Results: Forty-seven patients showed improved oxygenation and were successfully withdrawn from HFNC. In the binary logistic regression analysis, factors affecting mortality showed that age was the only variable predictive of inhospital all-cause mortality. In the factors affecting intubation, logistic regression revealed greater shunt fraction would increase the odds of being intubated. Conclusion(s): HFNC has low success rate in covid19 critical patients but significantly showed benefit in those with shunt fraction <30%. Additionally, this study was not able to show the benefit of HFNC in terms of mortality and length of hospital stay.
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Background: The Interferon (IFN)-gamma pathway, including its receptor subunits (IFNAR1 and IFNAR2), is related to hyperinflammation and lower viral clearance in COVID-19. IFNAR2 and the soluble form of the protein have been associated with COVID-19 severity. Aim(s): We aimed to evaluate the association of the IFNAR2 rs2236757, rs1051393, rs3153, rs2834158, and rs2229207 with the clinical outcome (survivors and non-survivors) of patients with severe COVID-19. Method(s): The study included 1,136 patients (67% males, median 56 years old) with severe COVID-19, hospitalized in the Instituto Nacional de Enfermedades Respiratorias, a tertiary care hospital in Mexico. Variants were assessed using Taqman assays. The association study was performed using PLINK v2. Result(s): Four hundred and fifteen patients died during the hospital stay (36.5%). We found higher minor allele frequencies of the rs2236757, rs3153, and rs2834158 among non-survivors compared with survivors. The analyses of genotypes also showed associations of the dominant model for the three variants (Table 1). The rs2834158 was also associated with a logistic regression model adjusted for age (p= 0.038). Conclusion(s): IFNAR2 variants contribute to the genetic risk for mortality in patients with severe COVID-19. (Table Presented).
ABSTRACT
Following COVID-19 pandemic, rationning in intensive care unit (ICU) became common. This can lead to delay ICU admissions of severe patients and affect global prognosis. we aimed to assess clinical characteristics and outcomes of COVID-19 patients requiring ICU admission in terms of hospitalisation's delay. This study was performed at the zaghouan's hospital ICU, a 10-bed secondary ICU in Tunisia. It was a retrospective observationnal study including all severly COVID-19 patients admitted between March 20th, 2020 and February 15th, 2022. 2 groups were identified : Early ICU transfer (G1) was defined as admission within 48 hours of hospital stay, and late transfer (G2) was defined as an admission after 48 hours of hospital stay. During the study period, 1609 patients had required hospitalisation in our hospital, among them 365 (22.7%) were secondary transfered to ICU. A total of 163 patients were included in G1 and 202 patients were assigned to G2. Comorbidities were similar between the 2 groups. Mean ages were respectively 54.7+/-14.8 vs 58+/-12.5 years (p=0.019). Means SAPS II and APACHE II scores were respectively 22.3+/-9 vs 24+/-8.5 (p=0.03) and 7.5+/-4 vs 7.6+/-4.5 (p=0.8). On ICU admission, PaO2/FiO2 was higher in G1 (137+/-84mmHg vs 128+/-77 mmHg, p=0.4). There was no difference in ventilatory strategy between the two groups. Need for tracheal intubation was lower in G1 (37.4% vs 44%) (p=0.25). Length of ICU stay was similar in two groups (8.8+/-3.4 days vs 9+/-4.5 days). In-ICU mortality was significantly lower in G1 (35.6% vs 48.5%;p=0.028). Delay of ICU admission was associated with higher mortality. Better organizaion was needed to establisch optimal decision-making process.