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1.
Archives of Iranian Medicine ; 25(7):443-449, 2022.
Article in English | EMBASE | ID: covidwho-2067651

ABSTRACT

Background: This study aimed to investigate CURB-65, quick COVID-19 Severity Index (qCSI) and quick Sepsis Related Organ Failure Assessment (qSOFA) scores in predicting mortality and risk factors for death in patients with COVID-19. Method(s): We retrospectively analyzed a total of 1919 cases for whom the rRT-PCR assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive. For mortality risk factors, univariate and multivariate logistic regression analyses were used. Receiver operator characteristics (ROC) analysis and Kaplan-Meier survival analysis were performed for CURB-65, qCSI and qSOFA scores. Result(s): The patients' average age was 45.7 (21.6) years. Male patients accounted for 51.7% (n = 992). In univariate analysis, some clinical variables including age over 65 years and comorbid diseases such as hypertension, chronic kidney disease, malignancy, lymphopenia, troponin, lactate dehydrogenase (LDH) and fibrinogen elevation were associated with the mortality rate. In multivariate logistic regression analysis: Neutrophil lymphocyte ratio (NLR) 3.3 and above (OR, 9.1;95% CI, 1.9-42), C-reactive protein (CRP)30 mg/L and above (OR, 4.1;95% CI, 1.2-13.6), D-dimer 1000 ng/mL and above (OR, 4;95% CI, 1.5-10.7) and age (OR, 1.11;95% CI, 1.04-1.18-year increase) were identified as risk factors for mortality among COVID-19 patients. The CURB-65 and qCSI scores exhibited a high degree of discrimination in mortality prediction (AUC values were 0.928 and 0.865, respectively). Also, the qSOFA score had a moderate discriminant power (AUC value was 0.754). Conclusion(s): CURB-65 and qSCI scores had a high discriminatory power to predict mortality. Also, this study identified CURB-65, qCSI and qSOFA scores, NLR, CRP, D-dimer level, and annual age increase as important mortality risk factors. Copyright © 2022 Academy of Medical Sciences of I.R. Iran. All rights reserved.

2.
Swiss Medical Weekly ; 152:9S, 2022.
Article in English | EMBASE | ID: covidwho-2040960

ABSTRACT

Background: The COVID-19 pandemic remains a large contributor to the global burden of disease. SARS-CoV-2 RNAemia detection has been connected to higher mortality, but consistent data of solid organ transplant (SOT) recipients have not been analyzed. Aim: To determine and quantify RNAemia at hospital admission and its impact on robust unfavorable clinical outcomes. Methods: From January 6, 2020 to August 13, 2021, we followed a multicenter cohort of 408 immunocompetent and 47 SOT patients hospitalized with COVID-19. Outcome variables were 30-day allcause mortality and invasive mechanical ventilation. Multivariate Cox regression analyses were performed and a propensity score (PS) was calculated. Results: SARS-CoV-2 RNAemia was demonstrated in 104 (22.9%) patients. Those with RNAemia were more frequently transplanted and presented a higher proportion of severe symptoms and signs. Mortality was 29.8% (31/104) and 3.4% (12/351) in RNAemic and non-RNAemic patients (p <0.001). The multivariate analysis adjusted by PS selected CURB-65≥2 (HR, 3.61;95% CI, 1.18-11.01;p = 0.02) and RNAemia (HR, 7.46;95% CI, 2.41-25.38;p = 0.001) as independent predictors of death. In the PS matching, SOT patients showed higher prevalence of RNAemia (57.6% vs. 13.6%) and mortality (HR, 4.56;95% CI, 1.47-7.13;p = 0.01). Conclusions: Positive RNAemia is an independent predictor of unfavorable outcome in immunocompetent and SOT. High viral load was linked to worse prognosis in a univariate analysis. Our findings help elucidate the pathogenesis of SARS-CoV-2 and provide insights for the better management of patients.

3.
Egyptian Journal of Radiology and Nuclear Medicine ; 53(1), 2022.
Article in English | EMBASE | ID: covidwho-2009505

ABSTRACT

Background: The global pandemic respiratory infection COVID-19 has had a high mortality rate since early 2020 with a broad spectrum of symptoms and giving a high burden. This study used the chest X-ray radiologic severity index method to radiologically assess the degree of lung lesions and the CURB-65 score to clinically assess COVID-19 pneumonia patients associated with the incidence of death in hospitalized patients. Results: The research data were carried out from March 2020 to April 2021 based on patient medical records and chest X-rays at Doctor Kariadi General Hospital Semarang Indonesia. One hundred and five subjects were collected that fulfilled the inclusion and exclusion criteria. The CURB-65 score ≥ 2 had a significant relationship to the death event with a prevalence interval of 2.98 (95% CI, p = 0.000). The radiologic severity index ≥ 22.5 in initial chest X-ray signified a prevalence ratio of 2.24 (CI 95%, p = 0.004) and the radiologic severity index ≥ 29.5 in the second chest X-ray signified a prevalence ratio of 4.53 for the incidence of death (95% CI, p = 0.000). The combination of CURB-65 and the first chest X-ray radiologic severity index resulted in a prevalence ratio of 27.44, and the combination of CURB-65 and the second chest X-ray radiologic severity index resulted in a prevalence ratio of 60.2 which were significant for the mortality of hospitalized COVID-19 pneumonia patients. Conclusions: Chest X-ray radiologic severity index and CURB-65 score have a significant relevance with the death event in hospitalized patients with COVID-19 pneumonia and can thus be used as a predictor of mortality.

4.
Indian Journal of Critical Care Medicine ; 26:S1, 2022.
Article in English | EMBASE | ID: covidwho-2006312

ABSTRACT

Aim and background: Approximately 50% of the COVID-19 patients require intensive care due to pneumonia and respiratory failure. The CURB-65,3 CRB-654, A-DROP5 score, and Pneumonia Severity Index (PSI) scoring systems are established prognostic tools for community-acquired pneumonia (CAP). Similarly, the qSOFA score is a prognostic tool for critically ill patients. However, the utility of these scoring systems in the context of COVID-19 is yet to be established as a predictive tool for triage by means of rapid decision-making and preventive measures to combat the ongoing pandemic. Materials and methods: This observational, retrospective cohort study was conducted AIIMS, New Delhi during May to June, 2021 after obtaining institutional ethical committee approval (IEC-860/4.9.2020). Only the RT-PCR-proven patients >18 years among the institutionalized patients with severe acute respiratory infections (SARI) were included. Results: Out of the 235 included patients, 27.2% of patients required mechanical ventilation, and the overall period of hospital stay was 9 (5-13) days. While the SMART COP score with an AUC of 0.812 (95% CI 0.752-0.871), the PSI score with an AUC of 0.819 (95% CI 0.762- 0.877) obtained significant results for mortality, the A drop score with an AUC of 0.92 (0.897-0.954), and both the PSI (AUC of 0.964;95% CI 0.928-1.000), and the SMART COP (AUC of 0.925;95% CI 0.887-0.962) acquired the best result for intubation and thereby requirement of mechanical ventilation. Conclusion: Although the outcome of COVID-19 depends upon multiple factors the SMART COP, PSI, and A-drop scoring systems seem to be promising predictive tools for morbidity and mortality.

5.
Microb Pathog ; 171: 105735, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1996427

ABSTRACT

To improve the identification and subsequent intervention of COVID-19 patients at risk for ICU admission, we constructed COVID-19 severity prediction models using logistic regression and artificial neural network (ANN) analysis and compared them with the four existing scoring systems (PSI, CURB-65, SMARTCOP, and MuLBSTA). In this prospective multi-center study, 296 patients with COVID-19 pneumonia were enrolled and split into the General-Ward-Care group (N = 238) and the ICU-Admission group (N = 58). The PSI model (AUC = 0.861) had the best results among the existing four scoring systems, followed by SMARTCOP (AUC = 0.770), motified-MuLBSTA (AUC = 0.761), and CURB-65 (AUC = 0.712). Data from 197 patients (training set) were analyzed for modeling. The beta coefficients from logistic regression were used to develop a severity prediction model and risk score calculator. The final model (NLHA2) included five covariates (consumes alcohol, neutrophil count, lymphocyte count, hemoglobin, and AKP). The NLHA2 model (training: AUC = 0.959; testing: AUC = 0.857) had similar results to the PSI model, but with fewer variable items. ANN analysis was used to build another complex model, which had higher accuracy (training: AUC = 1.000; testing: AUC = 0.907). Discrimination and calibration were further verified through bootstrapping (2000 replicates), Hosmer-Lemeshow goodness of fit testing, and Brier score calculation. In conclusion, the PSI model is the best existing system for predicting ICU admission among COVID-19 patients, while two newly-designed models (NLHA2 and ANN) performed better than PSI, and will provide a new approach for the development of prognostic evaluation system in a novel respiratory viral epidemic.


Subject(s)
COVID-19 , Community-Acquired Infections , COVID-19/diagnosis , Community-Acquired Infections/epidemiology , Humans , Neural Networks, Computer , Prognosis , Prospective Studies , Retrospective Studies
6.
Med Microecol ; 14: 100061, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1996423

ABSTRACT

At the beginning of the SARS-CoV-2 pandemic, developing of new treatments to control the spread of infection and decrease morbidity and mortality are necessary. This prospective, open-label, case-control intervention study evaluates the impact of the oral intake of the probiotic yeast Kluyveromyces marxianus B0399 together with Lactobacillus rhamnosus CECT 30579, administered for 30 days, on the evolution of COVID-19 patients. Analysis of the digestive symptoms at the end of the follow up shows a benefit of the probiotic in the number of patients without pyrosis (100% vs 33.3%; p 0.05) and without abdominal pain (100% vs 62.5%; p 0.04). Results also show a better evolution when evaluating the difference in the overall number of patients without non-digestive symptoms at the end of the follow-up (41.7%, vs 13%; p 0.06). The percentage of improvement in the digestive symptoms (65% vs 88%; p value 0.06) and the global symptoms (digestive and non-digestive) (88.6% vs 70.8%; p value 0.03) is higher in the probiotic group. The probiotic was well tolerated with no relevant side effects and high adherence among patients. In conclusion, this coadjutant treatment seems to be promising, although results should be confirmed in new studies with higher number of patients.

7.
International Journal of Health Sciences ; 6:2776-2784, 2022.
Article in English | Scopus | ID: covidwho-1989167

ABSTRACT

Introduction: Diabetes Mellitus is a chief reason for morbidity and mortality globally. It is also a major comorbidity contributory factor in COVID-19. Patients with diabetes have an increased susceptibility to viral and bacterial infections, including those affecting the respiratory tract. Numerous scoring systems have been developed to evaluate and stratify the risk of Communityacquired Pneumonia (CAP). CURB 65 scorings are one of the time tested and relatively easy methods. However, comparative CURB 65 SCORE data analysing its correlation between diabetes mellitus (DM) & non - diabetic mellitus (NDM) in hospitalized covid 19 patients is lacking. Therefore, this study aimed to evaluate and perform a comparative analysis of CURB 65 scores between diabetic & non- diabetic hospitalized COVID 19 confirmed patients. Methods: This cross-sectional single-centre research evaluated hundred and forty COVID 19 positive patients with and without diabetes from April to June 2021. Following the evaluation of the glycemic status of the patient, CURB 65 scores were calculated. Cohorts were grouped as mild, moderate and severe illnesses, based on the CURB 65 score. Duration of hospitalisation, the requirement of the ventilator, ICU admission and mortality were recorded. Patients were monitored until they were discharged or deceasement. Results: Of the sixty-nine patients who were diabetic, 65.2 % had a mild illness, 30.4% had moderate and 4.3 % had severe illness. Of the rest 71 patients who were non-diabetic 97.2 % had mild, 2.8% had moderate and none had severe illness. There is a significant association between patients with and without diabetes when compared with their CURB 65 score with a p-value <0.0001 and a chi-square value of 24. Seventeen DM patients were hospitalised in ICU and 13 required ventilation, whilst only 4 NDM patients were in ICU and 3 required ventilator support. The mean value of the duration of hospital stay for the DM group was 9.25 days with an SD of ± 5.0. In comparison mean value for NDM cohorts was 7.01 days with an SD of ± 4.30. The difference was statistically significant with a p-value of 0.005. No mortality was noted in NDM patients. In contrast, 17 DM patients succumbed. The difference in mortality was statistically significant with a p-value of <0.0001. Conclusion: CURB 65 was found to be of increased value for diabetic patients. The severity of illness is more in the diabetes population than in the non-diabetic population. © 2022 The authors.

8.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927695

ABSTRACT

Rationale “Home hospital” is hospital-level substitutive care delivered at home for acutely ill patients who would traditionally be cared for in the hospital. Despite years of successful operations and evidence from randomized controlled trials, to our knowledge outcomes in the U.S. specifically for patients with respiratory disease have not been evaluated. Methods We performed a retrospective evaluation of all patients who were cared for in our home hospital program between 2016 and 2021. We compared patients requiring admission with respiratory disease (asthma exacerbation, COPD exacerbation, and any non-COVID pneumonia) to all other patients who received home hospital care (other general medical conditions such as heart failure and infectious processes). Patients entered the program either from the emergency department after it was determined they required admission or from the general medical ward after it was determined they required additional days of acute care. Patients were risk-stratified using peak flow (asthma), BAP-65 (COPD), and CURB- 65 (pneumonia), among other scores to prognosticate against the ICU. Upon admission at home, patients received 2 nurse/paramedic visits daily, 1 physician visit daily, IV medications, advanced respiratory therapies, continuous heart and respiratory rate monitoring, and other hospital-level treatments/diagnostics as needed. Results Among 1,166 admissions, 25% were for respiratory disease (38% COPD, 38% pneumonia, and 24% asthma) and 75% were for non-respiratory disease (48% infection, 27% heart failure). Both groups had similar sociodemographic characteristics: mean age 72 years (SD, 17), 63% female, 44% White, 39% partnered, 71% English-speaking, 52% Medicare beneficiary, and 58% retired. Groups differed by education, with less attainment in the respiratory group (34% high school vs 29%;p=0.034), smoking status (20% active smoker vs 9%;p<0.001), and more outpatient medications (median number, 10 vs 8;p<0.001). During home hospital, respiratory patients had less utilization: length of stay (mean days, 3.4 vs 4.8;p<0.001), laboratory orders (median, 0 vs 2;p<0.001), consultations (1% vs 7%;p=0.004), and physical/occupational therapy (2% vs 7%;p=0.032). Both groups had a similar escalation rate (i.e., requiring transfer back to the hospital) of 4% and no mortality during home hospital. Within 30-days of discharge, both groups were similar: 14% readmission, 9% ED presentation, and 4% mortality. Conclusions Home hospital care is safe and effective for patients with acute respiratory illness compared to other general medical conditions. If scaled, it can serve to generate significant high-value capacity creation for health systems and communities, with opportunities to advance the complexity of care delivered.

9.
Journal of Clinical and Experimental Hepatology ; 12:S43-S44, 2022.
Article in English | EMBASE | ID: covidwho-1859850

ABSTRACT

Background: COVID-19 has become a major health emergency worldwide. The characteristics and outcome of COVID-19 in patients with CLD remain unclear. Aims: CLD represents a major disease burden globally. Given this high burden, how different underlying liver conditions influence the outcome in patients with COVID-19 needs to be meticulously evaluated. So, we conducted this study to see the outcome of the patient and to look for predictors of severity and mortality in patients with CLD with COVID-19 infection. Methods: This was a single-center, observational study conducted at a tertiary care center. We recruit 50 consecutive patients of COVID-19 with CLD. Matched comparison group patients with CLD without COVID-19 collected retrospectively from historical data with 1:2 ratio using stratified sampling. Results: Mean age of the study population was 51 ± 12 years with the majority were male. Most patients (21/50) were presented with predominantly respiratory symptoms of which fever was the most common symptom (85%). Jaundice (70%) was the most common GI symptom. Twenty patients had ACLF. All patients with ACLF were having severe COVID-19 infection and succumb to multi-organ failure. Mortality was double in a patient with CLD with COVID-19 infection than historical control. Diabetes was the only comorbidity which was associated with severe infection. Patients in the severely ill subgroup had higher mortality, high creatinine, and raised D-dimer but lower lymphocytes count. (P <0.05). Multivariate logistic regression for severity showed that only D-dimer reached significance. CURB-65 score on admission and Child Turcotte Pugh score on admission correlates with mortality (P <0.05). Serum D-dimer level and reduced lymphocyte counts were associated with mortality on multivariate analysis. Conclusion: The presence of CLD in covid-19 patients was associated with a poor outcome. Raised D-dimer on admission can predict severe infection. Child-Pugh and CRUB65 scores were highly associated with non-survival among these patients.

10.
Lung India ; 39(SUPPL 1):S152, 2022.
Article in English | EMBASE | ID: covidwho-1857460

ABSTRACT

Background: The greatest difficulty during the COVID pandemic was in effective triaging of patients. A new scoring system was developed by our center in order to provide a holistic assessment of the illness including systemic manifestations. This study was to evaluate the effectiveness of the scoring system in comparison to CURB 65, the most commonly used screening tool for prognostic assessment of pneumonia. Aim: To compare CURB 65 and Covid Severity Score Predictor 50 in measuring prognosis in patients with COVID 19 illness Methods: 150 Patients with COVID 19 illness were enrolled . The COVID severity score PReDiCTOR 50 was designed in our set up during the pandemic to assess prognosis of disease. This is retrospective analysis to compare the efficacy of the predictor against CURB 65 in assessing prognosis of COVID 19 illness using receiver operator characteristic curves and associated area under the curve. \ Results: We studied 150 patients with COVID 19 illness. 35 died and 103 were discharged. The ability to predict ICU admission was higher for our scoring system (AUC 0.875 ) as compared to CURB 65 ( AUC 0.83). Conclusion: The Covid SeveriTy Score PReDiCTOR 50 was found to be more effective in prognostic assessment of COVID 19 illness in comparison to CURB 65, indicating the importance of holistic assessment of COVID.

11.
J Infect Dev Ctries ; 16(3): 409-417, 2022 03 31.
Article in English | MEDLINE | ID: covidwho-1855894

ABSTRACT

INTRODUCTION: Determining prognostic factors in patients with coronavirus disease (COVID-19) can have great impact on treatment planning and follow-up strategies. Herein, we aimed to evaluate prognostic factors and clinical scores for confirmed COVID-19 patients in a tertiary-care hospital in the Bursa region of Turkey. METHODOLOGY: Patients who had been diagnosed with COVID-19 microbiologically and/or radiologically between March and October 2020 in a tertiary-care university hospital were enrolled retrospectively. Adult patients (≥ 18 years) with a clinical spectrum of moderate, severe, or critical illness were included. The dependent variable was 30-day mortality and logistic regression analysis was used to evaluate any variables with a significant p value (< 0.05) in univariate analysis. RESULTS: A total of 257 patients were included in the study. The mortality rate (30-day) was 14.4%. In logistic regression analysis, higher scores on sequential organ failure assessment (SOFA) (p < 0.001, odds ratio (OR) = 1.86, 95% CI = 1.42-2.45) and CURB-65 pneumonia severity criteria (p = 0.001, OR = 2.60, 95% CI = 1.47-4.57) were found to be significant in predicting mortality at admission. In deceased patients, there were also significant differences between the baseline, day-3, day-7, and day-14 results of D-dimer (p = 0.01), ferritin (p = 0.042), leukocyte (p = 0.019), and neutrophil (p = 0.007) counts. CONCLUSIONS: In our study of COVID-19 patients, we found that high SOFA and CURB-65 scores on admission were associated with increased mortality. In addition, D-dimer, ferritin, leukocyte and neutrophil counts significantly increased after admission in patients who died.


Subject(s)
COVID-19 , Adult , COVID-19/diagnosis , COVID-19/mortality , Ferritins , Humans , Prognosis , ROC Curve , Retrospective Studies
12.
Virol J ; 18(1): 189, 2021 09 17.
Article in English | MEDLINE | ID: covidwho-1779657

ABSTRACT

BACKGROUND: The importance of clinicolaboratory characteristics of COVID-19 made us report our findings in the Alborz province according to the latest National Guideline for the diagnosis and treatment of COVID-19 in outpatients and inpatients (trial five versions, 25 March 2020) of Iran by emphasizing rRT-PCR results, clinical features, comorbidities, and other laboratory findings in patients according to the severity of the disease. METHODS: In this study, 202 patients were included, primarily of whom 164 had fulfilled the inclusion criteria. This cross-sectional, two-center study that involved 164 symptomatic adults hospitalized with the diagnosis of COVID-19 between March 5 and April 5, 2020, was performed to analyze the frequency of rRT-PCR results, distribution of comorbidities, and initial clinicolaboratory data in severe and non-severe cases, comparing the compatibility of two methods for categorizing the severity of the disease. RESULTS: According to our findings, 111 patients were rRT-PCR positive (67.6%), and 53 were rRT-PCR negative (32.4%), indicating no significant difference between severity groups that were not related to the date of symptoms' onset before admission. Based on the National Guideline, among vital signs and symptoms, mean oxygen saturation and frequency of nausea showed a significant difference between the two groups (P < 0.05); however, no significant difference was observed in comorbidities. In CURB-65 groups, among vital signs and comorbidities, mean oxygen saturation, diabetes, hypertension (HTN), hyperlipidemia, chronic heart disease (CHD), and asthma showed a significant difference between the two groups (P < 0.05), but no significant difference was seen in symptoms. CONCLUSION: In this study, rRT-PCR results of hospitalized patients with COVID-19 were not related to severity categories. From initial clinical characteristics, decreased oxygen saturation appears to be a more common abnormality in severe and non-severe categories. National Guideline indices seem to be more comprehensive to categorize patients in severity groups than CURB-65, and there was compatibility just in non-severe groups of National Guideline and CURB-65 categories.


Subject(s)
COVID-19 Nucleic Acid Testing/methods , COVID-19/diagnosis , Polymerase Chain Reaction/methods , SARS-CoV-2/isolation & purification , Adult , Aged , COVID-19/physiopathology , Comorbidity , Cross-Sectional Studies , Female , Hospitalization , Humans , Iran , Male , Middle Aged , SARS-CoV-2/genetics , Severity of Illness Index , World Health Organization
13.
Open Forum Infectious Diseases ; 8(SUPPL 1):S21-S22, 2021.
Article in English | EMBASE | ID: covidwho-1746808

ABSTRACT

Background. We aimed to explore a novel risk score to predict mortality in hospitalised patients with COVID-19 pneumonia. In additoon, we compared the accuracy of the novel risk score with CURB-65, qSOFA and NEWS2 scores. Methods. The study was conducted in hospitalised patients with laboratory and radiologically confirmed COVID-19 pneumonia between November 1, 2020 and November 30, 2020. In this retrospective multicenter study. independent predictors were identified using multivariate logistic regression analysis. A receiver operating characteristics (ROC) analysis with area under the curve (AUC) was used to evaluate the performance of the novel score. The optimal cut-off points of the candidate variables were calculated by the Youden's index of ROC curve. Mortality was defined as all cause in-hospital death. Results. A total of 1013 patients with COVID-19 were included. The mean age was 60,5 ±14,4 years, and 581 (57,4%) patients were male. In-hospital death was occured in 124 (12,2%) patients. Multivariate analysis revealed that peripheral capillary oxygen saturation (SpO2), albumin, D-dimer, and age were independent predictors for mortality (Table). A novel scoring model was named as SAD-60 (SpO2, Albumin, D-dimer, ≥60 years old). SAD-60 score (0,776) had the highest AUC compared to CURB-65 (0,753), NEWS2 (0,686), and qSOFA (0,628) scores (Figure). Conclusion. We demonstrated that SAD-60 score had a promising predictive capacity for mortality in hospitalised patients with COVID-19. Univariate and multivariate analysis of factors predicting mortality Comparison of CURB-65, qSOFA, NEWS-2 and SAD-60 for predicting pneumonia mortality in hospitalised patients with COVID-19 by ROC analysis.

14.
Diagnostics (Basel) ; 12(3)2022 Mar 13.
Article in English | MEDLINE | ID: covidwho-1742364

ABSTRACT

To date, the COVID-19 pandemic has caused millions of deaths across the world. Prognostic scores can improve the clinical management of COVID-19 diagnosis and treatment. The objective of this study was to assess the predictive role of 4C Mortality, CURB-65, and NEWS in COVID-19 mortality among the Romanian population. A single-center, retrospective, observational study was conducted on patients with reverse transcriptase-polymerase chain reaction (RT-PCR)-proven COVID-19 admitted to the Municipal Emergency Clinical Hospital of Timisoara, Romania, between 1 October 2020 and 15 March 2021. Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were performed to determine the discrimination accuracy of the three scores. The mean values of the risk scores were higher in the non-survivors group (survivors group vs. non-survivors group: 8 vs. 15 (4C Mortality Score); 3 vs. 8.5 (NEWS); 1 vs. 3 (CURB-65)). In terms of mortality risk prediction, the NEWS performed best, with an AUC of 0.86, and the CURB-65 score performed poorly, with an AUC of 0.80. CURB-65, NEWS, and 4C Mortality scores were significant mortality predictors in the analysis, with acceptable calibration. Among the scores assessed in our study, NEWS had the highest performance in predicting in-hospital mortality in COVID-19 patients. Thus, the findings from this study suggest that the use of NEWS may be beneficial to the early identification of high-risk COVID-19 patients and the provision of more aggressive care to reduce mortality associated with COVID-19.

15.
Rev Clin Esp (Barc) ; 222(1): 37-41, 2022 01.
Article in English | MEDLINE | ID: covidwho-1626054

ABSTRACT

OBJECTIVE: This article aims to assess the utility of CURB-65 in predicting 30-day mortality in adult patients hospitalized with COVID-19. METHODS: This work is a cohort study conducted between March 1 and April 30, 2020 in Ecuador. RESULTS: A total of 247 patients were included (mean age 60 ± 14 years, 70% men, overall mortality 41.3%). Patients with CURB-65 ≥ 2 had a higher mortality rate (57 vs. 17%, p < .001) that was associated with other markers of risk: advanced age, hypertension, overweight/obesity, kidney failure, hypoxemia, requirement for mechanical ventilation, or onset of respiratory distress. CONCLUSIONS: CURB-65  ≥ 2 was associated with higher 30-day mortality on the univariate (Kaplan-Meier estimator) and multivariate (Cox regression) analysis.


Subject(s)
COVID-19 , Adult , Aged , Cohort Studies , Ecuador/epidemiology , Female , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2
16.
Journal of Experimental and Clinical Medicine (Turkey) ; 38(4):434-439, 2021.
Article in English | EMBASE | ID: covidwho-1614651

ABSTRACT

This study aimed to determine whether the PSI, CURB-65, CALL and BCRSS had any superiority over each other as a prognostic determinant in patients with COVID-19. This prospective cohort study included patients over 18 years of age that presented to the emergency department between May 12 and August 12, 2020 and had a positive COVID-19 polymerase chain reaction (PCR) test. The PSI, CURB-65, CALL and BCRS scores were calculated. SPSS version 22 was used for all statistical analyses. A total of 213 patients with a positive COVID-19 PCR result were included in the study. The total 30-day mortality rate was determined as 14.08%. PSI, CURB-65, CALL and BCRSS had a statistically significant relationship with mortality (p<0.001). The best parameter in predicting mortality was determined as PSI (area under the curve: 0.900;95% CI: 0.972-0.828). A positive correlation was found between each scoring system, both with the length of hospital stay (PSI, CURB-65, CALL and BCRSS: r=0.696, p=0;r=0.621, p=0;r=0.75, p=0;and r=0.666, p=0, respectively). Scoring systems, which include comorbidity, vital signs as well as laboratory, imaging findings, will be more effective than other scoring systems in determining the mortality in patients with covid-19.

17.
Rev Clin Esp ; 222(1): 37-41, 2022 Jan.
Article in Spanish | MEDLINE | ID: covidwho-1609012

ABSTRACT

OBJECTIVE: This article aims to assess the utility of CURB-65 in predicting 30-day mortality in adult patients hospitalized with COVID-19. METHODS: This work is a cohort study conducted between March 1 and April 30, 2020 in Ecuador. RESULTS: A total of 247 patients were included (mean age 60 ± 14 years, 70% men, overall mortality 41.3%). Patients with CURB-65 ≥ 2 had a higher mortality rate (57 vs. 17%, p < .001) that was associated with other markers of risk: advanced age, hypertension, overweight/obesity, kidney failure, hypoxemia, requirement for mechanical ventilation, or onset of respiratory distress. CONCLUSIONS: CURB-65 ≥ 2 was associated with higher 30-day mortality on the univariate (Kaplan-Meier estimator) and multivariate (Cox regression) analysis.

18.
Cukurova Medical Journal ; 46(4):1449-1458, 2021.
Article in English | Web of Science | ID: covidwho-1579629

ABSTRACT

Purpose: The aim of this retrospective observational study is to compare C-reactive protein to albumin ratio and CURB-65 score in the emergency department in terms of predicting mortality in patients over the age of 18 who were hospitalized for COVID-19 pneumonia. Materials and Methods: The study includes 613 patients hospitalized between March 15 and April 30, 2020 due to COVID-19 pneumonia detected on thorax computed tomography at the emergency department pandemic area. Hospitalized patients were divided into groups according to positive and negative real-time polymerase chain reaction results. Results: While 73.1% (n: 448) of 613 patients included in the study were hospitalized in the ward, 26.9% (n: 165) were hospitalized in intensive care. 8.6% (n: 53) of the total patients died. In non-survivors patients the mean CURB 65 score was 4 +/- 1 (and C-Reactive Protein to Albumin Ratio was 5.6 +/- 4.2 Multivariate logistic regression analysis showed that CURB 65 and high C-Reactive Protein to Albumin Ratio are independent risk factors for COVID19 pneumonia. Conclusion: The C-reactive protein to albumin ratio is as sensitive as CURB 65 and can guide the clinician in the early detection of patients with poor prognosis COVID19 pneumonia.

19.
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.

20.
Acta Endocrinol (Buchar) ; 17(1): 83-89, 2021.
Article in English | MEDLINE | ID: covidwho-1380036

ABSTRACT

CONTEXT: The effects of COVID-19 on the adrenocortical system and its hormones are not well known. OBJECTIVES: We studied serum cortisol, serum adrenocorticotropic hormone (ACTH), and their ratio in hospitalized non-critically ill COVID-19 patients. DESIGN: A prospective case-control study. METHODS: The study participants were divided into 2 groups. Group 1 consisted of 74 COVID-19 patients. The second group consisted of 33 healthy persons. Early admission above hormones levels was determined and compared between the study groups. Besides that, COVID-19 patients were grouped according to their Glasgow Coma Score (GCS), CURB-65 score, and intensive care unit (ICU) requirement, and further sub-analyses were performed. RESULTS: There were no significant differences in the mean age or gender distribution in both groups. In the patients' group, the serum ACTH concentration was lower than in the healthy group (p<0.05). On the other hand, the serum cortisol levels and cortisol/ACTH ratio of the patients' group were significantly higher than of the healthy controls (p<0.05, all). Further analyses showed that, although serum cortisol and ACTH levels were not high, the cortisol/ACTH ratio was higher in COVID-19 patients with low GCS (<15) than patients with normal GCS (=15) (p<0.05). In COVID-19 in patients with different CURB-65 scores, the cortisol/ACTH ratio was significantly different (p<0.05), while serum cortisol and ACTH were not different in groups (p>0.05). Serum cortisol levels and cortisol/ACTH ratio were higher but ACTH level was lower in the ICU needed COVID-19 patients than in patients who do not need ICU (p<0.05). CONCLUSION: Our pilot study results showed that the cortisol/ACTH ratio would be more useful than serum cortisol and/or ACTH levels alone in evaluating the adrenocortical system of COVID-19 patients. Still, further detailed studies are needed to confirm these.

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