Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 6 de 6
Filter
1.
Pakistan Armed Forces Medical Journal ; 72(2):345-348, 2022.
Article in English | Scopus | ID: covidwho-1912789

ABSTRACT

Objective: To study the histo-pathological findings in lung biopsies of critical COVID-19 cases. Study Design: Case series. Place and Duration of Study: Pakistan Emirates Military Hospital, Rawalpindi Pakistan, from Jul to Dec 2020. Methodology: Deceased patients who remained on ventilatory support with a confirmatory diagnosis of SARS-CoV-2 both by PCR and radiological evidence on HRCT and clinically established severity of disease as per CALL scoring were included in the study. Written informed consent for lung biopsy was taken from the deceased's next of kin Result: Mean age of the study group was 67.20 ± 6.01 years. The patients had a mean high resolution computed tomography score of 36.73 ± 1.59, and the mean CALL score was 12.73 ± 0.691 on admission. The average time after intensive care unit admission to intubation was 1.23 ± 0.50 days. Histopathological examination of the lung biopsy showed 27 (87.1%) patients had the exudative stage of adult respiratory distress syndrome while three (9.7%) patients had a proliferative stage of adult respiratory distress syndrome. Conclusion: Histopathological findings of an exudative stage of adult respiratory distress syndrome in the lung biopsies of critical COVID-19 showed no significant difference with typical adult respiratory distress syndrome and are correlated with very high mortality rates in critical COVID-19. © 2022, Army Medical College. All rights reserved.

2.
COVID-19 Pnömonisi Tanısı ile Yatarak Tedavi Gören Hastalarda CALL Skorun Prognostik Performansı. ; 17(4):359-366, 2021.
Article in English | Academic Search Complete | ID: covidwho-1590989

ABSTRACT

Objective: Scoring systems are frequently used to predict disease severity and mortality in many different clinical conditions. The prognostic significance of a new scoring system developed for patients who are hospitalized due to Coronavirus disease-2019 (COVID-19) pneumonia, which is named CALL that stands for comorbidity (C), age (A), lymphocyte count (L), and lactate dehydrogenase (LDH) (L), was evaluated. Methods: This is a retrospective and observational study on 582 patients who were hospitalized due to moderate or severe COVID-19 pneumonia after being diagnosed as positive using the real-time polymerase chain reaction testing. CALL scores were evaluated in the two groups of patients, namely the survivors and the non-survivors. Results: Among all patients, 339 (58.24%) were males and 272 (46.73%) were older than 60 years. Comorbidities were not found in 174 (29.89 %) patients, whereas 408 (70.11%) had one or more comorbidities, mainly hypertension (n=275, 47.25%), diabetes mellitus (n=192, 32.98%), and coronary artery disease (n=78, 13.4%). Class A consist of 113 (19.41%) patients (4-6 s), 219 (37.62%) in Class B (7-9 s), and 250 (42.95%) in Class C (10-13 s). In-hospital mortality was found to be 6% (35 cases). Only 1 (0.88%) patient in Class A and 27 (10.8%) in Class C were deceased. As a result, in-hospital mortality was observed as 27 patients in Class C and 1 in Class A. The receiver operating characteristic analysis was used to assess the performance of the CALL score;the area under the curve was 0.76 (95% confidence interval of 0.68-0.85). Using a cutoff value of 10 points, the sensitivity was 77% and specificity was 60% for predicting in-hospital mortality. Conclusion: CALL score was observed to be strongly related to in-hospital mortality. As a simple diagnostic measure, it may be used as a complementary score for the treatment planning and management of COVID-19 pneumonia in pandemic conditions. (English) [ FROM AUTHOR] Amaç: Hastalık şiddetinin belirlenmesi ve prognozun öngörülmesinde çeşitli skorlama sistemleri kullanılmaktadır. Mevcut çalışmada, Koronavirüs hastalığı-2019 (COVID-19) pnömonisinde yüksek riskli hastaların saptanması amacı ile geliştirilen, 4 parametreden oluşan ve CALL skor C: komorbidite, A: yaş, L: lenfosit sayısı ve L: laktat dehidrojenaz (LDH) olarak adlandırılan, yeni bir skor sisteminin sonucu öngörebilme yetisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: 1 Eylül 2020-31 Aralık 2020 tarihleri arasında yatarak tedavi gören, Ters transkripsiyon polimeraz zincir reaksiyonu testi ile doğrulanmış, orta ve ağır şiddetli COVID-19 pnömonisi olan hastaların tıbbi kayıtlarının retrospektif analizi yapıldı. Çalışmaya toplam 582 hasta dahil edildi. CALL skoru sonuçları sağ kalanlar ve kaybedilenler olmak üzere iki hasta grubu için karşılaştırıldı. Bulgular: 339 (%58,24) erkek hastanın olduğu çalışmada, 272 (%46,73) hastanın 60 yaş üzerinde olduğu saptandı. 174 (%29,89) hastada herhangi bir komorbidite bulunmazken 408 (%70,11) hastada bir veya daha fazla komorbidite olduğu gözlendi. Komorbiditeler arasında ilk üç sırada hipertansiyon (275, %47,25), diyabet (192, %32,98) ve koroner arter hastalığı (78, %13,4) yer almaktaydı. CALL skoru sınıflamasına göre;113 (%19,41) hasta sınıf A (4-6 puan), 219 (%37,62) hasta sınıf B (7-9 puan) ve 250 (%42,95) hasta sınıf C (10-13 puan) olarak kaydedildi. Sınıf A'da sadece 1 (%0,88) hastanın, sınıf C'de ise 27 (%10,8) hastanın kaybedildiği saptandı. Hastane içi mortalite oranı %6 (35 hasta) bulundu. Kaybedilen toplam 35 hasta değerlendirildiğinde;27 hastanın sınıf C, 7 hastanın sınıf B ve 1 hastanın sınıf A kategorisinde bulunduğu gözlendi. CALL skorun performansını değerlendirmek amacı ile kullanılan Receiver operating characteristics analizinde arena eğri altında 0,76 (%95 güven aralığı, 0,68-0,85) bulundu. Cutoff değeri 10 puan olarak kabul edildiğinde, CALL skorun hastane içi mortaliteyi öngörmede %77 duyarlılık ve %60 özgüllüğe sahip olduğu saptandı. Sonuç: CALL skorun hastane içi mortalite ile güçlü bir şekilde ilişkili olduğu gözlendi. CALL skoru, özellikle pandemi koşulları dikkate alındığında COVID-19 pnömonisinin tedavi yönetiminde basit, yardımcı ve tamamlayıcı bir skor olarak kullanılabilir. (Turkish) [ FROM AUTHOR] Copyright of Medical Journal of Bakirkoy is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

3.
Infez Med ; 29(3): 408-415, 2021.
Article in English | MEDLINE | ID: covidwho-1444695

ABSTRACT

INTRODUCTION: There is the need of a simple but highly reliable score system for stratifying the risk of mortality and Intensive Care Unit (ICU) transfer in patients with SARS-CoV-2 pneumonia at the Emergency Room. PURPOSE: In this study, the ability of CURB-65, extended CURB-65, PSI and CALL scores and C-Reactive Protein (CRP) to predict intra-hospital mortality and ICU admission in patients with SARS-CoV-2 pneumonia were evaluated. METHODS: During March-May 2020, a retrospective, single-center study including all consecutive adult patients with diagnosis of SARS-CoV-2 pneumonia was conducted. Clinical, laboratory and radiological data as well as CURB-65, expanded CURB-65, PSI and CALL scores were calculated based on data recorded at hospital admission. RESULTS: Overall, 224 patients with documented SARS-CoV-2 pneumonia were included in the study. As for intrahospital mortality (24/224, 11%), PSI performed better than all the other tested scores, which showed lower AUC values (AUC=0.890 for PSI versus AUC=0.885, AUC=0.858 and AUC=0.743 for expanded CURB-65, CURB-65 and CALL scores, respectively). Of note, the addition of hypoalbuminemia to the CURB-65 score increased the prediction value of intra-hospital mortality (AUC=0.905). All the tested scores were less predictive for the need of ICU transfer (26/224, 12%), with the best AUC for extended CURB-65 score (AUC= 0.708). CONCLUSION: The addition of albumin level to the easy-to-calculate CURB-65 score at hospital admission is able to improve the quality of prediction of intra-hospital mortality in patients with SARS-CoV-2 pneumonia.

4.
Ther Adv Infect Dis ; 8: 20499361211040325, 2021.
Article in English | MEDLINE | ID: covidwho-1379752

ABSTRACT

INTRODUCTION: In response to the evolution of the coronavirus disease 2019 (COVID-19) pandemic, the admission protocol for the temporary COVID-19 hospital in Mexico City has been updated to hospitalize patients preemptively with an oxygen saturation (SpO2) of >90%. METHODS: This prospective, observational, single-center study compared the progression and outcomes of patients who were preemptively hospitalized versus those who were hospitalized based on an SpO2 ⩽90%. We recorded patient demographics, clinical characteristics, COVID-19 symptoms, and oxygen requirement at admission. We calculated the risk of disease progression and the benefit of preemptive hospitalization, stratified by CALL Score: age, lymphocyte count, and lactate dehydrogenase (<8 and ⩾8) at admission. RESULTS: Preemptive hospitalization significantly reduced the requirement for oxygen therapy (odds ratio 0.45, 95% confidence interval 0.31-0.66), admission to the intensive care unit (ICU) (0.37, 0.23-0.60), requirement for invasive mechanical ventilation (IMV) (0.40, 0.25-0.64), and mortality (0.22, 0.10-0.50). Stratification by CALL score at admission showed that the benefit of preemptive hospitalization remained significant for patients requiring oxygen therapy (0.51, 0.31-0.83), admission to the ICU (0.48, 0.27-0.86), and IMV (0.51, 0.28-0.92). Mortality risk remained significantly reduced (0.19, 0.07-0.48). CONCLUSION: Preemptive hospitalization reduced the rate of disease progression and may be beneficial for improving COVID-19 patient outcomes.

5.
Respir Med Res ; 79: 100826, 2021 May.
Article in English | MEDLINE | ID: covidwho-1221020

ABSTRACT

BACKGROUND: Early recognition of the severe illness is critical in coronavirus disease-19 (COVID-19) to provide best care and optimize the use of limited resources. OBJECTIVES: We aimed to determine the predictive properties of common community-acquired pneumonia (CAP) severity scores and COVID-19 specific indices. METHODS: In this retrospective cohort, COVID-19 patients hospitalized in a teaching hospital between 18 March-20 May 2020 were included. Demographic, clinical, and laboratory characteristics related to severity and mortality were measured and CURB-65, PSI, A-DROP, CALL, and COVID-GRAM scores were calculated as defined previously in the literature. Progression to severe disease and in-hospital/overall mortality during the follow-up of the patients were determined from electronic records. Kaplan-Meier, log-rank test, and Cox proportional hazard regression model was used. The discrimination capability of pneumonia severity indices was evaluated by receiver-operating-characteristic (ROC) analysis. RESULTS: Two hundred ninety-eight patients were included in the study. Sixty-two patients (20.8%) presented with severe COVID-19 while thirty-one (10.4%) developed severe COVID-19 at any time from the admission. In-hospital mortality was 39 (13.1%) while the overall mortality was 44 (14.8%). The mortality in low-risk groups that were identified to manage outside the hospital was 0 in CALL Class A, 1.67% in PSI low risk, and 2.68% in CURB-65 low-risk. However, the AUCs for the mortality prediction in COVID-19 were 0.875, 0.873, 0.859, 0.855, and 0.828 for A-DROP, PSI, CURB-65, COVID-GRAM, and CALL scores respectively. The AUCs for the prediction of progression to severe disease was 0.739, 0.711, 0,697, 0.673, and 0.668 for CURB-65, CALL, PSI, COVID-GRAM, A-DROP respectively. The hazard ratios (HR) for the tested pneumonia severity indices demonstrated that A-DROP and CURB-65 scores had the strongest association with mortality, and PSI, and COVID-GRAM scores predicted mortality independent from age and comorbidity. CONCLUSION: Community-acquired pneumonia (CAP) scores can predict in COVID-19. The indices proposed specifically to COVID-19 work less than nonspecific scoring systems surprisingly. The CALL score may be used to decide outpatient management in COVID-19.


Subject(s)
COVID-19/mortality , Severity of Illness Index , Aged , Aged, 80 and over , Cohort Studies , Disease Progression , Female , Hospital Mortality , Hospitalization , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Turkey/epidemiology
6.
Cureus ; 12(11): e11368, 2020 Nov 07.
Article in English | MEDLINE | ID: covidwho-972700

ABSTRACT

BACKGROUND:  Coronavirus disease 2019 (COVID-19) is a novel infectious disease of multi-system involvement with significant pulmonary manifestations. So far, many prognostic models have been introduced to guide treatment and resource management. However, data on the impact of measurable respiratory parameters associated with the disease are scarce. OBJECTIVE:  To demonstrate the role of Comorbidity-Age-Lymphocyte count-Lactate dehydrogenase (CALL) score and to introduce Respiratory Assessment Scoring (RAS) model in predicting disease progression and mortality in COVID-19. METHODOLOGY:  Data of 252 confirmed COVID-19 patients were collected at Pak Emirates Military Hospital (PEMH) from 10th April 2020 to 31st August 2020. The CALL score and proposed factors of RAS model, namely respiratory rate, oxygen saturation at rest, alveolar arterial gradient and minimal exercise desaturation test, were calculated on the day of admission. Progression of disease was defined and correlated with measured variables. Univariate and multivariate Cox regression analysis for each variable, its hazard ratio (HR) and 95% confidence interval (CI) were calculated, and a nomogram was made using the high-risk respiratory parameters to establish the RAS model. RESULTS:  Progression of disease and death was observed in 124 (49.2%) and 49 (19.4%) patients, respectively. Presence of more than 50% of chest infiltrates was significantly associated with worsening disease and death (p-value <0.001). Death was observed in 100% of patients who had critical disease category on presentation. Regression analysis showed that the presence of comorbidity (n: 180), in contrast to other variables of CALL score, was not a good prognosticator of disease severity (p-value: 0.565). Nonetheless, the CALL model itself was validated to be a reliable prognostic indicator of disease progression and mortality. Some 10 feet oxygen desaturation test (HR: 0.99, 95%CI: 0.95-1.04, p--value: 0.706) was not a powerful predictor of the progression of disease. However, respiratory rate of more than 30 breaths/minute (b/m) (HR: 3.03, 95%CI: 1.77-5.19), resting oxygen saturation of less than 90% (HR: 2.41, 95%CI: 1.15-5.06), and an elevated alveolar-arterial oxygen gradient (HR: 2.14, 95%CI: 1.04-4.39) were considered statistically significant high-risk predictors of disease progression and death, in the formed RAS model. The model resulted in 85% (95%CI: 80%-89%) of area under the receiver operating characteristic curve (AUROC), with substantial positive (76%, 95%CI: 68%-83%) and negative predictive values (80%, 95%CI: 73%-87%) for a cutoff value of seven. Patients with higher CALL and RAS scores also resulted in higher mortality. CONCLUSION:  CALL and RAS scores were strongly associated with progression and mortality in patients with COVID-19.

SELECTION OF CITATIONS
SEARCH DETAIL